• Archives of Plastic Surgery
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• 제32권3호
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• pp.271-280
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• 2005

There are various types of flap in head and neck reconstruction. We chose the appropriate flap considering the indication and patient's condition. In case of conventional flaps, its type is decided according to the reconstruction site. In other words, the types of considerable flaps are limited in a way. But, perforator flaps can reduce donor limitation and harvest flaps depending on the condition of the recipient. Therefore, the flap is very useful for the head and neck reconstruction needed for 2-dimensional or 3-dimensional reconstruction. We report the 29 cases of perforator-based flap including 8 cases of latissimus dorsi perforator free flap, 5 thoracodorsal perforator free flap, 4 anterolateral thigh perforator free flap, 3 peroneal osteocutaneous perforator free flap and 9 submental perforator island flap for the head and neck reconstruction. Free flaps include 2 cases of chimeric pattern, 7 controlled resurfacing pattern, 4 3-D pattern, 3 dermoadiposal pattern, 1 folded pattern and 3 osteocutaneous pattern. The flaps were successfully used for the head and neck reconstruction. But one patient died during a follow up period because of the recurrence of tumor. Various perforator flaps(island/free pattern) can be highly competitive to the conventional flaps in the head and neck reconstruction, considering a thin character for resurfacing, more flexible and versatile option, variable composition, long pedicle with donor structures saved, and less prominent donor morbidity.

• Archives of Reconstructive Microsurgery
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• 제4권1호
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• pp.23-32
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• 1995

Severe upper and lower extremity trauma may result in soft tissue loss with exposed bone and the subsequence of risk of chronic osteomyelitis or malunion of fracture fragments. Such injuries present a major reconstructive problem. But Since the introduction of microsugical technique, free muscle and myocutaneous flaps were employed to provide coverage of severely injured defects. Since Tai and Hasegawa(1974) first reported a breast reconstruction using by rectus abdominis myocuraneous flap, the free rectus myocutaneous flap has been widely employed for breast reconstuction, head and neck reconstruction, and extremity reconstruction in these days. The authors present their successful experience with free rectus abdominis muscle and rectus abdominis myocutaneous flaps for upper and low extremity reconstruction. From Nov. 94, to May 95, Five cases of severely injured extremites due to trauma or contact burn were treated with free rectus abdominis muscle flap or free rectus abdominis myocutaneous flap. All flaps except 1 case were survived without severe complications. As free muscle or myocutaneous flap, the free rectus abdominis flap has the advantages of a reliable pedicle, easy dissection, and an acceptable donor site, so it seems logical to apply the free rectus abdominis flap to apply in upper and lower extremity reconstruction.

• The Journal of Korean Physical Therapy
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• 제14권1호
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• pp.27-37
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• 2002

This is the study of the knee joint injured patients at the orthopaedic surgery clinic where is located in Daejon, who has MCL combine injured ACL reconstruction caused by sport activity and accident during the period from Jan. 2001 to Oct. 2001. By comparing with groups between 7th case of I-group for MCL combined stitch and II-group for ACL reconstruction since 6weeks cast. We have been concluded with that following results. 1. Range of motion for the knee was not limited at 5th case(37%) of I-group, 6th case(42%) of II-group and the cases of Flexion deficit less then 10 -degree were 2nd case(13%) of I-group and II-group 1st case(8%) with no extension deficit more then 5 -degree. 2. The level of activity that tells you whether you are capable of exercise for six month after operation. It han been divided by 3 levels. The case of capable of doing low risk exercise(swimming, cycling, etc.) was 5th case of I-group, the case of capable of doing medium risk exercise(jogging, etc.) was 3rd case of I-group and 4th case of II-group and the case of capable of doing high risk exercise(football, etc.) were 3rd case of I-group and 3rd case of II-group. 3. The timing of the return to their job were average 6.4 weeks for I-group and average 22.9 weeks for II-group(P<.05, statistical difference). 4. There was no statistical difference between I-group and II-group for the timing of the return to their job(P>.05). 5. By using VAS to compare them there was no statistical difference between I-group and II-group of clinical results according to Lysholm scale.

• Archives of Reconstructive Microsurgery
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• 제5권1호
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• pp.80-91
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• 1996

A free rectus abdominis flap can include a variable amount of muscle length depending on recipient site requirements. There is also great flexibility in flap design in terms of size, orientation of its axis, and the level of its location over the muscle. It is safe to design the skin island across the midline. Though skin islands designed over the most inferior portion of the abdomen have not always proved reliable when based on the superior epigastric artery, free flaps based on the inferior pedicle can be successfully designed in this area. As free flap based on the inferior epigastric vessels, this flap has been useful for large head and neck defects following ablative procedures, for facial contour restoration as a buried flap, for upper extremity defects, for lower extremity defects such as coverage of grade III tibial fractures and for breast reconstruction. A free rectus abdominis muscle or myocutaneus flap was used in 8 patients. The operations were performed between Sep. of 1994 and April of 1996. The patients were tongue cancer 1 case, chronic facial palsy 1 case, unilateral breast reconstruction 1 case, upper and lower extremity injury 5 cases. The free rectus abdominis muscle flaps were 4 cases and the free myocutaneous flaps were 4 cases. There was no failure of the flap, except one partial necrosis. One case of the skin grafts on the muscle flap was regrafted. One case of reoperation due to venous thrombosis was performed. In tongue cancer patient, a orocutaneous fistula was occurred, but conservative treatment and secondandry skin graft were done. In conclusion, a free rectus abdominis flap has many advantages such as a long and constant pedicle, easy dissection, enough soft tissue available, scar on the donor site to be hiddened, no need for changing position. So we think that this flap is the most useful one for small or moderate sized defects on the various sites.

• 대한두개안면성형외과학회지
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• 제11권1호
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• pp.13-18
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• 2010

Purpose: Nasal defect can be caused by excision of tumor, trauma, inflammation from foreign body reaction. Nose is located in the middle of face and protruded, reconstruction should be done in harmony with size, shape, color, and textures. We report various methods of nasal reconstruction using local flaps. Methods: From March 1998 to July 2008, 36 patients were operated to reconstruct the nasal defects. Causes of the nasal defects were tumor (18 cases), trauma (11 cases), inflammation from foreign body reaction (5 cases) and congenital malformation (2 cases). The sites of the defects were ala (22 cases), nasal tip (8 cases) and dorsum (6 cases). The thickness of the defects was skin only (5 cases), dermis and cartilagenous layer (7 cases) and full-thickness (24 cases). According to the sites and thickness of the defects, various local flaps were used. Most of alar defects were covered by nasolabial flaps or bilobed flaps and the majority of dorsal and tip defects were covered by paramedian forehead flaps. Small defects below $0.25 cm^2$ were covered with composite graft or full-thickness skin graft. Results: The follow-up period was 14 months. Partial flap necrosis was observed in a case, and one case of infection was reported, it was improved by wound revision and antibiotics. Nasal reconstruction with various local flaps could provide satisfactory results in terms of color and texture match. Conclusion: The important factors of nasal reconstruction are the shape of reconstructed nose, color, and texture. Nasolabial flap is appropriate method for alar or columellar reconstruction and nasolabial island flap is suitable for tip defect. The defect located lateral wall could be reconstructed with bilobed flap for natural color and texture. Skin graft should be considered when the defect could not afford to be covered by adjacent local flap. And entire nasal defect or large defect could be reconstructed by paramedian forehead flap.

• 한국도로학회논문집
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• 제18권3호
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• pp.33-45
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• 2016

PURPOSES : Concrete pavement has been used in the construction of the Jungbu expressway in 1987. More than 60% of the pavement on the expressway is currently made of concrete, but most has been used far beyond their design life. Pavement life has been extended through routine maintenance or overlay. However, the structural capacity of the pavement has reached its limit, and extensive rehabilitation/reconstruction with long time traffic blocking should be considered. The three following issues on concrete rehabilitation/reconstruction will be discussed: (1) economic comparison of asphalt inlay and asphalt overlay, (2) economic comparison preventive overlay on a section which is currently good and routine overlay on the section which will be poor, and (3) economic analysis of early-strength concrete when it is used in concrete reconstruction. METHODS : First, various life cycle cost analysis tools were compared, and the proper tool for the extensive rehabilitation/reconstruction was selected. Second, a sensitivity analysis of the selected tool was performed to find the influential input variables, which should be carefully selected in the analysis. Third, three case studies, which can be issues in the rehabilitation/reconstruction of the expressway concrete pavement in Korea, were performed. RESULTS : Asphalt overlay without milling the deteriorated concrete showed 18~25% lower life cycle cost than the current asphalt inlay with milling. The good current preventive overlay on the section was economically justified within the scope of this study. The construction cost limit of the early strength concrete was suggested to be economical for 1, 3, and 7 days of construction alternative opening. CONCLUSIONS : CA4PRS was a viable tool for comparing various rehabilitation/reconstruction issue alternatives. Several concrete issues associated with the rehabilitation/reconstruction of the deteriorated concrete pavement were discussed as mentioned above.

• Archives of Reconstructive Microsurgery
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• 제19권1호
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• pp.56-60
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• 2010

Purpose: Breast reconstruction with abdominal flap has many advantages. However, it might cause abdominal complications such as bulging or hernia. SIEA (Superficial inferior epigastric artery) flap is the most advanced form of abdominal flap which has no adverse effect on abdominal fascia. We report 2 cases of breast reconstruction with SIEA flap with reference review. Methods: From Jun 2006 to Jan 2009, 110 patients underwent breast reconstruction with free abdominal flap. We tried to find the SIEA in every cases and adopted SIEP flap if the diameter was larger than 1mm and it had visible pulsation. 2 patients underwent breast reconstruction with SIEA flap. After design of abdominal flap SIEA was investigated with portable Doppler. SIEA was usually found 4-5 cm lateral to the midline. Flap was elevated with SIEA and SIEV to their maximal length at hiatus. Results: There were no complications, such as infection, hematoma, and necrosis of flap. In both cases, flaps survived completely with excellent vascularity and breast reconstruction was successful. In one case, there was skin necrosis of mastectomy flap, and it was healed by conservative management. Conclusion: With the SIEA flap, donor site morbidity can be minimized along with reduction of operation time. If there is reliable SIEA, SIEA flap would be the preferred skills. However, the limitation of the SIEA flap is difficulty in identifying the SIEA. The reason for less availability of the flap in Korea might include high prevalence of the Caesarian section scar and relatively higher level of the lower margin of the flap.

• Archives of Plastic Surgery
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• 제36권4호
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• pp.397-405
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• 2009

Purpose: Soft tissue defect of anterior chest wall is caused by trauma, infection, tumors and irradiation. To reconstruct damaged anterior chest wall does require to consider the patient's body condition, the cause, the location, the depth and the size of deletion, the circulation of surrounding tissue and minimization of functional and cosmetic disability. In this report, we suggest the algorithm of configuration for reconstruction methods. Methods: A retrospective study of 20 patients who underwent anterior chest wall reconstruction with pedicled musculocutaneous flap and fasciocutaneous flap was conducted. We collected the information of the patient's body condition, the cause, the size, the depth and the location of deletion, implemented flap and complication. We observed and evaluated flap compatibility, functional and cosmetic results. Patients completed survey about the extent to their satisfaction. Result: Follow up period after surgery was from 6 to 26 months, survival of flap were confirmed in all of patients' case. Two cases of local necrosis, one case of wound disruption were reported, but all these were cured by the debridement and primary closure. One hematoma and one seroma formation were observed in donor site. Longer surgery time, more bleeding amount and more transfusion volume were reported in the group of musculocutenous flap. Conclusion: Long term follow up result showed the successful reconstruction in all patients without recurrence and with minimal donor site morbidity. In addition, the patients' satisfaction for cosmetic and functional results were scaled relatively higher. This confirmed the importance of reconstruction algorithm for the chest wall reconstruction.

• 보존과학회지
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• 제32권4호
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• pp.561-570
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• 2016

이 연구는 심곡사칠층석탑의 해체와 재조립에 3차원 영상분석 기법을 적용하여 원형에 가깝게 보수한 기술적 사례로써 의미가 있다. 석탑의 해체와 재조립 과정에서 전체적인 변형상태와 변위를 분석하였으며 구조적 안정성 검토를 통하여 재조립에 따른 변형을 최소화하였다. 또한 석탑의 원위치도 재검토하여 보수에 적용하였다. 재조립에 앞서 오염된 석재의 표면은 과학적 표면세정을 통해 이끼류와 지의류 등을 제거하였고, 석탑의 지반은 강회를 이용한 판축과 유사한 형식으로 다짐하여 보강하였다. 이 결과는 석탑의 해체와 재조립 과정에 중요한 자료로 활용될 수 있을 것이다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제40권6호
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• pp.272-277
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• 2014

Objectives: Non-vascularized iliac crest bone graft (NVIBG) is a known treatment option in mandibular reconstruction following jaw resection, but no documented review of patients treated with NVIBG exists for northern Nigeria. The experience and technique from a Nigerian tertiary hospital may serve as baseline data for comparison and improvement of practice for other institutions. Materials and Methods: A retrospective review of medical records and patient case files from January 2012 to December 2013 was undertaken. All case files and other medical records of patients who had reconstruction with NVIBG for benign or malignant lesions with immediate or delayed reconstruction were selected for review. Results: Twenty patients had mandibular reconstruction with NVIBG during the study period. Two patients were excluded because of incomplete medical records. Eighteen patients' (male=14, female=4) records were reviewed. Their ages ranged from 13 to 62 years (mean $26.0{\pm}10.6years$). Indications for NVIBG included jaw tumors (n=16; 88.3%), jaw cyst (n=1; 5.6%) and gunshot injury (n=1; 5.6%). Jaw tumors seen were ameloblastoma (n=15; 83.3%) and osteosarcoma (n=1; 5.6%). Treatments done were mandibular resection with condylar resection (n=7; 38.9%), mandibular segmental resection (n=10; 55.6%) and subtotal mandibulectomy (n=1; 5.6%). Patients' postoperative reviews and radiographs revealed good facial profile and continued bone stability up to 1 year following NVIBG. Conclusion: NVIBGs provide an acceptable alternative to vascularized bone grafts, genetically engineered bone, and distraction osteogenesis for mandibular reconstruction in resource-limited centers.