• Archives of Plastic Surgery
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• v.32 no.4
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• pp.447-453
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• 2005

The coverage of soft tissue defects around the knee joint or upper one third of lower leg presents a difficult challenge to the reconstructive surgeon. Various reconstructive choices are available depending on the location, size and depth of the defect. The authors present their clinical application of a medial sural artery perforator island flap as a useful alternative method for upper one third of lower leg and knee reconstruction. From 2002 to 2004, we operated total 4 patients (total 4 flaps) using the medial sural artey perforator island flap for coverage of the defect on upper one third of lower leg and knee, of 4 patients, 3 patients was men and one was woman. Average patient age was 54.6 years. The largest flap obtained was 10x8cm2. Postoperative follow up of the patients ranged from two to 33 months. In two cases, defects was located on upper one third of lower leg and in other two cases, defects were on the knee. All four cases had bone exposure open wound. In angiography, 2 cases had injured in the anterior tibial artery, 1 case had injured in the posterior tibial artery. There were no diabetes or other vascular disease. All 4 flaps were survived completely, without minor complications such as venous congestion and hematoma. Donor morbidity was restricted substantially to the donor linear scar. There were no functional impairment. As the main advantages of the medial sural perforator island flap, it ensures constant location and reliable blood supply without sacrificing any main source artery or damaging underlying muscle. This procedure is valuable extension of local flap for defect coverage with minimal functional deficit donor site and good aesthetic result on the defect. We consider it as one of the useful methods of the upper one third of lower leg and knee reconstruction.

• Archives of Reconstructive Microsurgery
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• v.13 no.1
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• pp.24-28
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• 2004

The vascularity of a skin island in fibula osteocutaneous free flap often depends on musculocutaneous perforators that find their origin in the proximal peroneal artery. But a potential drawback has been reported on the unreliability of the skin paddle. The perforating vessels to the skin paddle of the fibula osteocutaneous free flap were rarely derived from a common tibio-fibula trunk, an anterior tibial artery and a posterior tibial artery. Previous studies have emphasized total loss of the overlying skin paddle, if the expected perforating vessels are not present. We report here on our experience that the skin paddle of the fibula osteocutaneous free flap was vascularized not by a peroneal artery but a direct branch of the posterior tibial artery. There were no intraseptal nor intramuscular pedicles in the posterior crural septum which connected to the overlying skin island. Therefore, we performed microsurgical anastomoses between distal peroneal vessels of the fibula and the perforating branches of the posterior tibial vessels of the skin paddle. The anastomosed skin paddle was salvaged with a peroneal flow through vascular anastomosis and was transferred to the bone and intraoral soft tissue defects with the fibula graft. The patient had no evidence of vascular compromise in the postoperative period and showed good healing of the intraoral skin flap.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.40
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• pp.41.1-41.4
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• 2018

Background: Free fibular flap is one of the most useful methods in the hard tissue reconstruction of the maxillamandible. Free fibular flap presents some advantages in which the reconstruction of both soft and hard tissues can be done at the same time. It also provides a safe and successful bone graft for the reconstruction, along with a low rate of complications. Despite these advantages and the rarity of a postoperative complication, particularly in oral and maxillofacial surgery procedures, a prolonged operation might exhibit some complications related with rhabdomyolysis. We experienced the rare event of rhabdomyolysis after oral cancer surgery. Case presentation: In this article, we report the case of a patient who developed rhabdomyolysis after undergoing free fibular flap surgery. Conclusions: Despite the advantages of the free fibular flap operation, clinicians must be aware of the risk of complications because there are multiple factors that could result in rhabdomyolysis, such as duration of operation, position of the subject, and pre-existing conditions of diabetes and hypertension. Once the diagnosis of rhabdomyolysis is confirmed, a prompt treatment plan should be made and applied as soon as possible. This will increase the chance of a full recovery for the patient who is exhibiting symptoms of rhabdomyolysis.

• Archives of Plastic Surgery
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• v.36 no.5
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• pp.571-577
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• 2009

Purpose: The Provision of thin and pliable tissue and the adequate coverage of tendon - gliding surface is necessary for a soft tissue defect of the hand with exposure of bone, tendon and muscle. This report will discuss our experience with anterolateral thigh fascial free flap for the reconstruction of the soft tissue defect of the hand. Methods: Between February 2004 and August 2008, seven patients with full - thickness soft tissue defects of the hand were reconstructed by means of a composite anterolateral thigh fascial free flap. There were soft tissue defects associated with trauma (n=5), scar contracture (n=1) and necrosis due to ischemia (n=1). Flaps were harvested from the anterolateral thigh as adipofascial flaps with only a small sheet of fascia and fatty tissue above it. The fascia and the skin of the donor site was closed directly and delayed split - thickness skin graft was performed. Result: All flaps survived completely. The size of the transferred flap ranged from $2{\times}4cm$ to $5{\times}8cm$. Thin flap coverage was possible without secondary debulking operations. It left minimal donor site morbidity with a linear scar. In one case, the thigh muscle herniation in the donor site was developed. Conclusion: The anterolateral thigh fascial free flap provided thin and pliable tissue which can establish a tendon - gliding mechanism, minimal bulk, minimal donor site morbidity. The disadvantages of this technique were the need for a skin graft and the muscle herniation of donor site.

• Archives of Plastic Surgery
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• v.49 no.1
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• pp.70-75
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• 2022

Background Fingertip injuries are very common; however, the reconstruction of volar pulp defects with nail bed defects is challenging in the absence of the amputated segment. We reconstructed fingertip amputations with nail bed defects using a new surgical approach: a subcutaneous flap and composite graft. Methods We treated 10 fingertip amputation patients without an amputated segment, with exposed distal phalangeal bone and full-thickness nail bed defects between February 2018 and December 2020. All patients underwent two-stage surgery: in the first stage, a subcutaneous flap was performed to cover the exposed distal phalanx, and in the second stage, a composite graft, consisting of nail bed, hyponychium, and volar pulp skin, was applied over the subcutaneous flap. Results All flaps survived and all composite grafts were successful. The wounds healed without any significant complications, including the donor site. The average follow-up duration was 11.2 months (range, 3-27 months). The new nail and the shape of the volar pulp were evaluated during follow-up. All patients were satisfied with their natural fingertip shapes and the new nails did not have any serious deformities. Conclusions A subcutaneous flap in combination with a composite graft fitting the shape of the defect could be another option for fingertip injuries without amputated segments.

• Archives of Reconstructive Microsurgery
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• v.7 no.2
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• pp.135-145
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• 1998

In 1980 Morrison and O'Brien reported their experiences about the reconstruction of amputated thumb using wrap-around neurovascular free flap from the great toe with a nonvascularized iliac bone graft. From then it has been considered to be a good reconstructive procedure for the amputated thumb, but it's indication has been limited distal to the metacarpophalangeal(MP) joint. We have performed 37 cases of wrap-around free flap from the great toe for the reconstruction of thumb amputated at distal or proximal to the MP joint and investigated their functional results according to the level of amputation. Level of amputation was distal to the MP joint in 25 cases and proximal to it in 12 cases. Pinching and grasping power, two point discrimination and the amount of opposition to the other fingers were compared to the uninjured hand. Pinching and grasping power were not significantly different according to the level of amputation but the amount of two point discrimination was significantly high in the cases amputated proximal to the MP joint. The opposition of reconstructed thumb to the other fingers was completely possible in all cases amputated distal to the MP joint. In 12 cases amputated proximal to the MP joint of the thumb, opposition was completely possible in 6 cases in which the iliac bone block was fixated in the position of $30^{\circ}$ flexion and $45^{\circ}$ internal rotation but in 6 cases in the fixation of $30^{\circ}$ flexion and $30^{\circ}$ internal rotation, the opposition of reconstructed thumb to the ring and little fingers were impossible in 5 cases and only to the little finger in 1 case. In this study, we concluded that even if amputation proximal to the MP joint, it is no more contraindication of the wrap-around free flap procedure for thumb reconstruction, however in these cases we recommend iliac bone block fixation in the position of $30^{\circ}$ flexion and $45^{\circ}$ infernal rotation for the better functional outcome.

• Journal of Periodontal and Implant Science
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• v.39 no.1
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• pp.71-76
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• 2009

Purpose: Many researches showed loss of alveolar bone in fresh extraction socket and even in case of immediate implant placement. The aim of this study was to evaluate the effect of non-resorbable barrier membrane on the change of buccal and lingual alveolar bone in immediate implant placement into periapically infected extraction sockets. Materials and methods: Immediate implants were placed into artificially induced periapical lesion of mandibular premolars after complete debridement using buccal bone defect made by a 6mm trephine bur in 4 mongrel dogs. Before flap repositioning, a non-resorbable barrier membrane was placed on the buccal defect in the experimental group. No membrane was placed in the control group. In 12 weeks after placement, the dogs were sacrificed and undecalcified histologic specimens were prepared. The vertical distance from the smooth-rough surface interface(SRI) to gingiva, 1st bone contact and bone crest were measured in buccal and lingual side. The horizontal thicknesses of gingiva and bone at 0, 1, 2 and 3mm below SRI were measured. Results: The buccal bone was resorbed more than lingual bone in both groups and there was statistical significance(p<0.05). The distances from SRI to 1st bone contact were $2.45{\pm}2.35\;mm$ in experimental group and $4.49{\pm}3.10\;mm$ in control group. In all vertical level, lingual bone was thicker than buccal bone(p<0.05). Conclusion: Buccal bone was reduced more than lingual bone in immediate implant placement into periapically infected extraction sockets. Placement of non-resorbable barrier membrane reduced the buccal bone resorption. However there was no statistical significance.

• Journal of Trauma and Injury
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• v.20 no.2
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• pp.119-124
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• 2007

Purpose: Management of the soft tissue defect in the lower extremity caused by trauma has always been difficult. Coverage with local and free muscle flaps after complete surgical excision of necrotic soft tissue and bone is a major strategy for treatment. There is no doubt that muscle provides a good blood supply, thus improving bone healing and increasing resistance to bacterial inoculation. However, accompanying problems are seen in cases with shallow dead space. This research was conducted to assess the efficacy of raising anterolateral thigh flaps and transferring them to the defect after complete debridement of non-viable, infected, and scar tissue as an alternative way to use local or free muscle flaps. Methods: From March 2005 to October 2007, 18 cases of soft tissue defect on lower extremities were re-surfaced with an anterolateral thigh perforator free flap. Results: The follow-up period ranged from 1 to 31 months with a mean of 15.9 months. All flaps survived completely. Satisfactory aesthetic and functional results were achieved. Under a two-point discrimination test, 13 patients had sensory recovery from 11 mm to 20 mm after 6 months postoperatively. Conclusion: Reconstruction of the lower extremity with anterolateral thigh perforator free flaps after appropriate debridement is a good alternative way to use local or free muscle flaps.

• Archives of Plastic Surgery
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• v.39 no.4
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• pp.417-421
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• 2012

We present a case of a near total amputation at the distal tibial level, in which the patient emphatically wanted to save the leg. The anterior and posterior tibial nerves were intact, indicating a high possibility of sensory recovery after revascularization. The patient had open fractures at the tibia and fibula, but no bone shortening was performed. The posterior tibial vessels were reconstructed with an interposition saphenous vein graft from the contralateral side and a usable anterior tibial artery graft from the undamaged ipsilateral distal portions. The skin and soft tissue defects were covered using a subatmospheric pressure system for demarcating the wound, and a latissimus dorsi myocutaneous free flap for definite coverage of the wound. At 6 months after surgery, the patient was ambulatory without requiring additional procedures. Replantation without bone shortening, with use of vessel grafts and temporary coverage of the wound with subatmospheric pressure dressings before definite coverage, can shorten recovery time.

• Journal of Chest Surgery
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• v.31 no.1
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• pp.89-91
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• 1998

Tuberculosis infection is wide spread disease and makes troublesome complications in some cases. A 50 - year old male visited Andong Hospital with coughing and sputum, dyspnea on exertion, bulging left anterior chest wall mass. Chest X-ray showed right pleural effusion, both side streaky infiltraion, and pleural thickness in apex. Chest CT scan showed bone destruction of left clavicle head, manubrium and large abscess pocket in pectoralis muscle. In May 1996 he underwent en bloc resection of left upper anterior chest wall including pectoralis major and minor muscle, left clavicle head, manubrium and covering infected skin, then contralateral pectoralis major muscle flap and skin graft was done. Patient shows no evidence of recurrence during follow up.