• Archives of Plastic Surgery
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• v.33 no.6
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• pp.784-788
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• 2006

Purpose: For the reconstruction of the ankle joint as well as the soft tissue defect in the distal lower leg, a free flap or a local flap has been used, and because of the condition of patients, if a complex microvascular surgery under general anesthesia could not be performed, it could be reconstructed by using the distally based lateral supramalleolar fascio-cutaneous island flap using the perforating branch of the peroneal artery in the ankle area. Methods: The study subjects were 4 male patients between 53 years and 73 years of age. 2 cases were tissue defect in the medial malleolus area due to systemic diseases such as gouty arthritis accompanied traffic accident, diabetes mellitus foot, atherosclerotic obliterans, etc., 1 case was the defect in the pretibia area, and 1 case was the defect underneath the lateral malleolus, which was reconstructed by the distally based lateral supramalleolar fascio-cutaneous island flap. The donor area was the skin harvested from the groin, and the full thickness skin graft was performed. The size of the flap varied from $4{\times}3cm$ to $9{\times}6cm$. As the flap border, the medial side was to the tibialis anterior tendon, the lateral side was to the fibula crest, and the proximal area was less than the fibula size. Results: The consequence is that, in total 4 cases, the congestion in the flap began from 12 hours after the surgery, and the progression of congestion was ceased on the 5th day after the surgery, and finally epidermal bulla and sloughing, partial necrosis was developed. After the end of necrosis, the defect area was reconstructed successfully by the second full thickness skin graft. Conclusions: Although the distally based lateral supramalleolar fascio-cutaneous island flap has the shortcoming of requiring the second skin graft, it has the advantages that it does not require a long complex microsurgery, the flap itself is thin, it is similar to the color of the skin in the recipient area, and it does not leave a big scar in the donor area. Therefore, it is thought that for the cases who could not undergo a long complex surgery due to systemic diseases or the cases of patients whose condition of the recipient area is not suitable for microsurgery, the lateral supramalleolar fascio-cutaneous island flap is very useful for the reconstruction of the distal lower leg and the ankle joint area.

• Archives of Reconstructive Microsurgery
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• v.19 no.1
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• pp.1-6
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• 2010

Schwannoma of the brachial plexus region is very rare. There has not been general agreement in terms of surgical outcome from limited number of studies. We analyzed surgical outcomes from 11 cases of schwannomas which occurred in the brachial plexus. From February 2000 to August 2009, 11 patients with schwannomas of the brachial plexus region were surgically treated by a single surgeon. We retrospectively reviewed the medical records and MRI of our cases, and evaluated the neurologic deficit and the recurrence of tumors after surgery. All the cases were proven histologically as schwannomas. The mean age of the patients was 52.6(36~67) years old, 4 of them were male and 7 were female. The tumor was located in the left side in 9 patients, and right in 2. The mean postoperative follow-up was 24.7(6~78) months. Initial presentation was usually painless, palpable mass. The mass was located in various level of the brachial plexus such as root, trunk, cord, or terminal branch level. The size of mass was from $1.5{\times}1.5{\times}0.5$ cm to $11.0{\times}10.0{\times}6.0$ cm. Eight of 11 patients showed no neurologic deficit. Three patients showed postoperative neurologic deficit; two of them had transient sensory deficit, and one of them had weakness of flexor pollicis longus and 2nd flexor digitorum profundus. There were no recurrences. The schwannoma of the brachial plexus region should be considered as a curable lesion with an acceptable surgical risk of injury to neurovascular structures. With precise surgical techniques, these tumors can be removed to improve patient's symptoms with minimal morbidity.

• Archives of Reconstructive Microsurgery
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• v.15 no.1
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• pp.17-25
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• 2006

Twelve cases in eleven patients with segmental bone defects were treated with contralateral fibula free flap and ipsilateral island fibula flap in an antegrade, retrograde or bidirectional flow fashion. Five cases were managed with free flaps and seven were with ipsilateral fibula island transfer. Among seven cases, antegrade fashion was three, retrograde was three, and bidirectional was one. All patients were related with open tibial fractures and its sequelae except one who had open foot bone fracture. According to Gustilo's classification, ten patients were type IIIb and one was type IIIc. Basically, antegrade-flow flaps based on the peroneal vessels as in the conventional free flap were used for the proximal or middle one-third tibial defects. On the contrary, retrograde-flow flaps based on the communicating branch between the peroneal and posterior tibial vessels were used for the middle or distal one-third of the tibia. Bidirection-flow flap based on intact peroneal vessels were used for the middle portion of the tibia. The patients who have undergone ipsilateral fibula island flap had one of the following problems: a previously failed free flap, below-knee amputation of the opposite leg because of open tibial fracture, refusal to use the contralateral sound leg, or poor general condition to stand a lengthy operation. Six of the patients who have got ipsilateral fibula island flap also had an associated fibula fracture on the same leg, which was ultimately used as one of the osteotomy sites. The follow-up period was from 1 to 10 years. Two cases of free flap were failed: one patient had below-knee amputation and the other patient had ipsilateral fibula transfer. Other cases were successful and excellent hypertophy of the transferred fibula was achieved. Time to bone union ranged from 4 to 11 months. Time to full weight bearing was from 5 to 13 months after surgery. All of the transferred fibulas showed hypertrophy after weight bearing. In one case, stress fracture was developed during ambulation, which was healed conservatively. Nonunion occurred in two cases, which were treated with a long leg cast and cancellous bone graft, respectively. Length discrepancy of the legs was noted. The limb was shorter by an average 0.5 cm in three cases, longer by 1.1 cm in one case. In the case of island fibula transfer, limited arc of rotation was not a problem. Other disabling complications were not seen. We believe that these diverse modalities using a vascularized fibula will make us more comfortable to handle major bone defects.

• Archives of Plastic Surgery
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• v.38 no.3
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• pp.228-234
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• 2011

Purpose: Reconstruction of chest wall has always been a challenging problem. Muscle flaps for chest wall reconstruction have been helpful in controling infection, filling dead space and covering the prosthetic material in this challenge. However, when we use muscle flaps, functional and cosmetic donor site morbidities could occur. The authors applied and revised various partial muscle flaps and combination use of them to cover the prosthetic material for the chest wall reconstruction and evaluated the usefulness of partial muscle flaps. Methods: This study included 7 patients who underwent chest wall reconstruction using partial muscle flap to cover prosthetic material from 2004 to 2008. The pectoralis major muscle was used in anterior 2/3 parts of it leaving lateral 1/3 parts of it. The anterior 2/3 parts of the pectoralis major muscle were used while lateral 1/3 parts were left. In case of the rectus abdominis muscle flap, we used upper half of it, or we dissected it around its origin and then advanced to cover the site. The latissimus dorsi muscle flap was elevated with lateral portion of it along the descending branch of the thoracodorsal artery. If single partial muscle flap could not cover whole prosthetic material, it would be covered with combination of various partial muscle flaps adjacent to the coverage site. Results: Flap coverage of the prosthetic material and chest wall reconstructions were successfully done. There occurred no immediate and delayed post operative complications such as surgical site infection, seroma, deformity of donor site and functional impairment. Conclusion: When we use the muscle flaps to cover prosthetic material for chest wall reconstruction, use of the partial muscle flaps could be a good way to reduce donor site morbidity. Combination of multiple partial flaps could be a valuable and good alternative way to overcome the disadvantages of partial muscle flaps such as limitation of volume and size as well as flap mobility.

• Archives of Plastic Surgery
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• v.36 no.5
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• pp.559-564
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• 2009

Purpose: Surgical reconstruction of an ischial soft tissue defect presents a challenging problem owing to a high rate of recurrence, especially paraplegic patients. Although various muscle, musculocutaneous and fasciocuta - neous flaps have been used in the reconstruction of ischial soft tissue defect, it is still debated which type of flaps are the best. We had performed a relatively durable adductor magnus perforator island flap based on the perforators originated from the first medial branch of the profunda femoris artery for coverage of ischial soft tissue defect where was not a region universally reconstructed by perforator flap. Methods: From August 2005 until January 2008, the adductor magnus perforator island flap had been used for resurfacing of the ischial soft tissue defects in a series of 6 patients (4 male and 2 female). Ages ranged from 26 to 67 years (mean, 47.5 years), and follow - up period from 13 to 26 months (mean, 16.7 months). Causes were 4 pressure ulcers, 1 cellulitis and 1 suppurative keratinous cyst. Results: The sizes of these flaps ranged from 12 to 18 cm in length and 7 to 9 cm in width. The flaps survived in all patients. Marginal loss over the distal area of the flap by infection was noted in one patient, which was treated successfully with a subsequent split - thickness skin graft. Average thickness of the flap was 0.94 cm, which was more thicker than other perforator flaps. Long term follow - up showed a good flap durability. Conclusion: In planning a reconstructive option of ischial soft tissue defect, the adductor magnus perforator island flap is a relatively large cutaneous flap with a durable thickness. With proper patient selection, careful vascular dissection and postoperative management, we recommend this flap is a good and suitable option for coverage of the ischial soft tissue defect.

• Archives of Reconstructive Microsurgery
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• v.7 no.1
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• pp.62-67
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• 1998

The gracilis muscle is well suited to small and medium-sized soft tissue defects that cannot be adequately handled by simple rotational flaps and it will conform well to irregular contours, can be split longitudinally at both ends to allow cavities and awkwardly shaped spaces and can be transferred in part or in whole. The gracilis muscle used as a free muscle or musculocutaneous flap is small with a long, narrow contour and its vascular pedicle is a terminal branch of the medial femoral circumflex artery and vein. The aims of soft tissue reconstruction are to cover soft tissue defects, to clear up infection and to prepare for further surgical procedures. Authors have performed 12 gracilis muscle flaps in the lower extremities at Chonbuk National University Hospital from June 1994 through March 1998. The results were as follows. 1. 11 cases of 12(91.7%) were sustained from the crushing injury and secondary complications from the traffic accident. 2. The microsurgical anastomosis of one artery and two veins have performed in 6 cases(50%) of 12 and 11(91.7%) cases of 12 were successful at the third postoperative week and in the final result. 3. Gracilis muscle flap is the infetion-resistant and aesthetically acceptable performed in the lower leg 1/3 and the foot.

• Archives of Reconstructive Microsurgery
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• v.5 no.1
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• pp.24-34
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• 1996

There are many kinds of free flaps for management of extensive soft tissue defect of extremities in orthopaedic field. Free vascularized scapular flap is one of the most useful and relatively easy to application. This flap has been utilize clinically from early eighties by many microsurgical pioneers. Authors performed 102 cases of this flap from 1984 to 1995. We have to consider about the surgical anatomy of the flap, technique of the donor harvesting procedures, vascular varieties and anatomical abnormalities and success rate and the weak points of the procedure. This flap nourished by cutaneous branches from circumflex scapular vessels emerges from the lateral aspect of the subscapular artery 2.5-5cm from its lateral origin passing through the triangular space(bounded by subscapularis, teres minor, teres major, long head of triceps). The terminal cutaneous branch runs posteriorly around the lateral border of the scapular and divided into two major branches, those transeverse horizontally and obliquely to the fascial plane of overlying skin of the scapular body. We can utilize these arteries for scapular and parascapular flap. The vascular pedicle ranged from 5 to 10 cm long depends on the dissection, usually two venae comitantes accompanied circumflex scapular artery and its major branches. The diameter of the circumflex scapular artery is more than 1mm in adult, rare vascular variation. Surgical techniques : The scapular flap can be dissected conveniently with prone or lateral decubitus position, prone position is more easier in my experience. There are two kinds of surgical approaches, most of the surgeon prefer elevation of the flap from its outer border towards its base which known easier and quicker, but I prefer elevation of the flap from its outer border because of the lowering the possibilities of damage to vasculature in the flap itself which runs just underneath the subcutaneous tissue of the flap and provide more quicker elevation of the flap with blunt finger dissection after secure pedicle dissection and confirmed the course from the base of the pedicle. There are minimal donor site morbidity with direct skin closure if the flap size is not so larger than 10cm width. This flap has versatility in the design of the flap shape and size, if we need more longer and larger one, we can use parascapular flap or both. Even more, the flap can be used with latissimus dorsi musculocutaneous flap and serratus anterior flap which have common vascular pedicle from subscapular artery, some instance can combined with osteocutaneous flap if we include the lateral border of the scapular bone or parts of the ribs with serratus anterior. The most important shortcoming of the scapular free flap is non sensating, there are no reasonable sensory nerves to the flap to anastomose with recipient site nerve. Results : Among our 102 cases, overall success rate was 89%, most of the causes of the failure was recipient site vascular problems such as damaged recipient arterial conditions, and there were two cases of vascular anomalies in our series. Patients ages from 3 years old to 62 years old. Six cases of combined flap with latissimus dorsi, 4 cases of osteocutaneous flap for bone reconstruction, 62 parascapular flap was performed - we prefer parascapular flap to scapular. Statistical analysis of the size of the flap has less meaningful because of the flap has great versatility in size. In the length of the pedicle depends on the recipient site condition, we can adjust the pedicle length. The longest vascular pedicle was 14 cm in length from the axillary artery to the enter point cutaneous tissue. In conclusion, scapular free flap is one of the most useful modalities to manage the large intractable soft tissue defect. It has almost constant vascular pedicle with rare anatomical variation, easy to dissect great versatility in size and shape, low donor morbidity, thin and hairless skin.

• Archives of design research
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• v.19 no.5 s.67
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• pp.17-30
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• 2006

The early Joseon Dynasty is very important period of studying about Korean history of ceramics because various kinds of porcelain were produced like celadon, brown porcelain, white porcelain, inlaid white porcelain, blue porcelain etc, $\ulcorner$sejongsilrok$\lrcorner$ $\ulcorner$Jiriji$\lrcorner$ was published and Saongwon established its branch. Moreover, there also had a sudden political change to Joseon Dynasty, so ceramic industry in Gangjin was closed and artisans in Gangjin scattered to find safer place. One of these place was Imiwueri and Chuhyunri, Joongmohyun in Sangju.(the name of the place in that times, now Modongmyun) Also, Sangju in Gyeongsangbuk-Do is one of the places where can get materials for producing white porcelain, so artisans in Gangjin could migrate to the place during change of regime to Joseon Dynasty which based on Sung Confucianism. In $\ulcorner$Tejongsilrok$\lrcorner$, it mentioned specific areas like Joongmo, Hwaryeong in Sangju, Gyeongsang-Do and we can find out about situations of ceramic production in the early 15 centuries with producing dishes for a Royal family. $\ulcorner$Sejongsilrok$\lrcorner$ $\ulcorner$Jiriji$\lrcorner$ mentioned Imiwueri and Chuhyunri and Sangju produced the half of porcelains. In $\ulcorner$Gyeongsangdojiriji$\lrcorner$, Sangju takes charge of 8 spots which is one third of ceramic production. $\ulcorner$Gyeongsangdojiriji$\lrcorner$ and $\ulcorner$Sejongsilrok$\lrcorner$ $\ulcorner$Jiriji$\lrcorner$ were published with same goals at the same year. In $\ulcorner$Gyeongsangdosokchanjiriji$\lrcorner$, there was deleted nine spots which included high, middle, low level compared with $\ulcorner$Seiongsilrok$\lrcorner$ $\ulcorner$Jiriji$\lrcorner$, and in $\ulcorner$Donggukyeojiseungram$\lrcorner$ there was entirely deleted the locations of porcelain spots and potteries.

• Archives of design research
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• v.19 no.2 s.64
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• pp.261-272
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• 2006

As we cannot think of our lives without a nation, it is closely related to almost every part of our daily lives. The role of government is becoming more important in the complex modern society as an essential element of national authority even though the government has indirect and secondary characteristics in its functional performance. Therefore, the government has to be efficient in planning and executing its policies, and it needs to be representative and fair as part of a national authoritative community. In the 21st century when symbolic and cultural importance of images are becoming more important, it is crucial for the government organizations to have an integrated identity design system that can satisfy both of these requirements of the government. However, the C.I.(Corporate Identity) of each Korean administrative branch has been developed separately and sporadically, which resulted in lack of consistency as part of the government. Shape and material of their C.I.s that follow short term design trend and popularity also lack uniqueness which can be distinguished from those of any private corporation. This may show that our government lacks systematic administrative capability, since image of a feature represents its characteristics and reality, and their recognition and evaluation from others become identity of the feature. In this perspective, the purpose of this thesis is to suggest an identity design system that has certain rules and regularity with wide variety of possible alterations for the central administration in Korea. In order to represent this visually, identity design system with both integrity and variety of possible alteration is created based on traditional Korean culture, especially the concept of Umyang-ohaeng and Samjae.