• Archives of Reconstructive Microsurgery
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• 제13권1호
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• pp.43-50
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• 2004

One of the major advantages of microsurgical reconstruction for defects of the hand is that these techniques allow for selection of the most ideal tissue to reconstruct a particular defect, thus optimizing the functional and aesthetic outcome. The dorsalis pedis free flap is an excellent reconstructive tool for various hand reconstructions. It has a reliable vasculature with vessels that are relative large on a long pedicle. It provides thin pliable tissue and be innervated by deep peroneal nerve. Coupled with its thinness and pliability, it is ideal for innervated cover of critically sensitive area, especially such as the hand. Thus it can be used as a cutaneotendinous flap, or an osteocutaneous flap. Otherwise, the major criticism with this flap is related to its uncertain vascularity and the donor defect. It is the purpose of this paper to outline our technique of flap elevation and donor site closure and to indicate our current use of this flap in hand reconstruction. We have treated 10 cases (6 burn scar contracture cases, 4 acute hand trauma cases) of hand reconstruction from Dec. 3, 1997 to Mar. 4, 2004 using dorsalis pedis free flap. The key points for sucess in terms of a viable flap and acceptable donor site are the preservation of the critical dorsalis pedis-first dorsal metatarsal vascular axis and the creation of a viable bed for grafting. In addition, we substituted preserved superficial fat skin graft for split thickness skin graft and wet environment was offered for good graft take. Preserved superficial fat skin is defined as composite graft containing epidermis, dermis and superficial fat layer. With sufficient care in flap elevation and donor site closure, a good graft take of preserved superficial fat skin under wet environment can be achieved with no functional disability and minimal cosmetic deformity in donor site. This flap has proved itself to be a best choice for hand reconstruction.

• Archives of Plastic Surgery
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• 제43권6호
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• pp.586-589
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• 2016

A pressure sore wound is often extensive or complicated by local infection involving adjacent soft tissue and bone. In this case, a regional flap after simple debridement is not adequate. Here, we present a case of an extensive pressure sore in the sacral area with deep tissue infection. A 43-year-old female patient with a complicated sore with deep tissue infection had a presacral abscess, an iliopsoas abscess, and an epidural abscess in the lumbar spine. After a multidisciplinary approach performed in stages, the infection had subsided and removal of the devitalized tissue was possible. The large soft tissue defect with significant depth was reconstructed with a free latissimus dorsi musculocutaneous flap, which was expected to act as a local barrier from vertical infection and provide tensionless skin coverage upon hip flexion. The extensive sacral sore was treated effectively without complication, and the deep tissue infection completely resolved. There was no evidence of donor site morbidity, and wheelchair ambulation was possible by a month after surgery.

• Archives of Reconstructive Microsurgery
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• 제20권1호
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• pp.14-17
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• 2011

Autologous breast reconstruction after mastectomy in breast cancer patient is now increasing. The deep inferior epigastric artery (DIEA) free flap is well known as an ideal donor site for the microsurgical breast reconstruction. The branching pattern of the DIEA was well described in the literature. In that study, DIEA has three branching patterns near the arcuate line. We describe a case in which branching variation of the DIEA before entering the posterior surface of the rectus abdominis muscle. In three cases, DIEA originated from the external iliac artery ascended as a double trunk at 1cm, 2cm, and 4cm above the originating point, respectively. In one case, DIEA ascended as a single trunk along the linea alba toward to the umbilicus until it supply overlying subcutaneous tissue. Preoperative 3D computed tomographic angiography to identify the anomaly is recommended and meticulous dissection to the originating point of DIEA is needed.

• Archives of Plastic Surgery
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• 제49권1호
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• pp.34-38
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• 2022

The deep inferior epigastric perforator (DIEP) flap has been widely used for autologous breast reconstruction after mastectomy. In the conventional surgical method, a long incision is needed at the anterior fascia of the rectus abdominis muscle to obtain sufficient pedicle length; this may increase the risk of incisional hernia. To shorten the incision, several trials have investigated the use of endoscopic/robotic devices for pedicle harvest; however, making multiple additional incisions for port insertion and operating in the intraperitoneal field were inevitable. Here, we describe the first case, in which a DIEP free flap was successfully made using the da Vinci SP model. Our findings can help surgeons perform operations in smaller fields with a single port in the extraperitoneal space. Moreover, this method is expected to lead to fewer donor-related complications and faster healing.

• Archives of Reconstructive Microsurgery
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• 제17권2호
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• pp.94-100
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• 2008

In the past decade, there has been increasing breast reconstructions after mastectomy, and the abdomen has been the gold standard for donor site. TRAM (transverse rectus abdominis myocutaneous), MSTRAM (muscle sparing transverse rectus abdominis myocutaneous), DIEP (deep inferior epigastric artery perforator), SIEA (superficial inferior epigastric artery) flap has been widely used nowadays. Among them, DIEP free flap spares the whole rectus abdominis muscle and anterior rectus sheath resulting in decreased donor site morbidity. Between March of 2006 and February of 2008, six patients had undergone immediate breast reconstructions using DIEP free flap. The mean age of patients was 48.5 years. All patients had unilateral breast reconstructions. We dissected two perforators which were included in the unilateral pedicle. Thoracodorsal artery and its venae comitantes were chosen as recipient vessels. For venous anastomosis, we used the GEM Microvascular Anastomotic Coupler System (Synovis Micro Companies Alliance, Inc., Birmingham, Ala.) in four cases. All flaps were survived completely except one who showed fatty abdomen in old age. She showed repetitive vascular spasm intraoperatively. None of the patients had abdominal hernia, bulge or weakness. We believe that DIEP free flap provides a reliable method for autologous breast reconstruction if the patients are selected appropriately and performed by a skillful surgeon.

• Archives of Plastic Surgery
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• 제44권3호
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• pp.238-242
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• 2017

The most common anatomic variant seen in donor kidneys for renal transplantation is the presence of multiple renal arteries, which can cause an increased risk of complications. Accessory renal arteries should be anastomosed to the proper source arteries to improve renal perfusion via the appropriate vascular reconstruction techniques. In microsurgery, 2 kinds of vascular augmentation methods, known as 'supercharging' and 'turbocharging,' have been introduced to ensure vascular perfusion in the transferred flap. Supercharging uses a distant source of the vessels, while turbocharging uses vascular sources within the same flap territory. These technical concepts can also be applied in renal transplantation, and in this report, we describe 2 patients who underwent procedures using supercharging and turbocharging. In one case, the ipsilateral deep inferior epigastric artery was transposed to the accessory renal artery (supercharging), and in the other case, the accessory renal artery was anastomosed to the corresponding main renal artery with a vascular graft (turbocharging). The transplanted kidneys showed good perfusion and proper function. No cases of renal failure, hypertension, rejection, or urologic complications were observed. These microsurgical techniques can be safely utilized for renal transplantation with donor kidneys that have multiple arteries with a lower complication rate and better outcome.

• Archives of Plastic Surgery
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• 제32권4호
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• pp.435-440
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• 2005

The reconstruction of deep soft tissue defects of lower extremities combined with bone exposure has been difficult problems. When it is impossible to raise local skin flap, we have been usually used the gastrocnemius musculocutaneous flap, cross leg flap or free flaps. However, In musculocutaneous flap, aesthetical appearance of the calf is not appropriate because of too bulky flap. Although the success rate of the free flap has improved, still failure of flap occurs in cases of the chronic ischemic state. As the concepts of perforator flap has recently developed and widely used due to its thin flap thickness. Between January 2002 to December 2004, we treated 7 patients with soft tissue defect in leg with chronic ischemic limbs with perforator island flap. Preoperative angiography were done in all case and we used 2 medial sural perforator flaps, 1 anterior tibial artery perforator flap, 1 posterior tibial artery perforator flap, 3 anterolateral thigh perforator flap. Partial necrosis of flap was seen in one patient but no further surgical procedure was required for wound healed spontaneously. Perforator island flaps are thin, reduce donor site morbidity, conceal donor site with primary closure and it is useful for resurfacing soft tissue defect of lower extremities.

• 한국표면공학회:학술대회논문집
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• 한국표면공학회 2012년도 추계총회 및 학술대회 논문집
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• pp.131-133
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• 2012

The photoluminescence (PT) properties of Al-doped ZnO thin films grown by the sol-gel dip-coating method have been investigated. At 12 K, nine distinct PL peaks were observed at 2.037, 2.592, 2.832, 3.027, 3.177, 3.216, 3.260, 3.303, and 3.354 eV. The deep-level emissions (2.037, 2.592, 2.832, and 3.027 eV) were attributed to native defects. The near-band-edge (NBE) emission peaks at 3.354, 3.303, 3.260, 3.216, and 3.177 eV were attributed to the emission of the neutral-donor-bound excitons (D0X), two-electron satellite (TES), free-to-neutral-acceptors (e,A0), donor-acceptor pairs (DAP), and second-order longitudinal optical (2LO) phonon replicas of the TES (TES-2LO), respectively. According to Haynes' empirical rule, we calculated the energy of a free exciton (FX) to be 3.374 eV. The thermal activation energy for D0X in the nanocrystalline ZnO thin film was found to be ~25 meV, corresponding to the thermal dissociation energy required for D0X transitions.

• 한국전기전자재료학회:학술대회논문집
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• 한국전기전자재료학회 1992년도 춘계학술대회 논문집
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• pp.97-100
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• 1992

The Degradation mechanism of the ZnO-varistor fabricated with the content of a 3-Composition seed grain is discussed using the method of Thermally Stimulated Current (TSC). The spectra of TSC is measured in the temperature range of -130～270$^{\circ}C$ with a various forming electric fields E$\sub$f/, temperature T$\sub$f/ time tf, and a various rising rate of temperature. It is observed that there are appeared the peaks of ${\alpha}$, ${\alpha}$$_2$, ${\beta}$ and ${\gamma}$from high temperature in a TSC spectrum. It seems that ${\alpha}$$_1$ peak is due to thermal depolarization of donor ions forming the space charge in the depletion layer, and ${\alpha}$$_2$peak is due to the detrapping of trapped electrons in deep trap level of intergranular layer, and ${\beta}$ peak is due to the thermal exciting of carrier existing in the donor level of grain itself, and ${\gamma}$ peak is due to the thermal exciting of trapped carrier in all shallow trap site randomly distributed in the inner of sample and/or a intrinsic impurity existing in it.

• Archives of Plastic Surgery
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• 제32권2호
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• pp.199-204
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• 2005

The nose is the most prominent area of the face, therefore susceptible to trauma and skin cancer. When small sized defect is in nasal tip, it results in disturbance of the facial harmony even if replantation, composite graft, skin graft or median forehead flap has been used for the reconstruction. So it is needed that the best method reconstruction is performed according to the degree of defect or deformity. And at the same time the physiology and anatomy of nose were clarified and its aesthetic subunits were employed. How can we cover the about 3 cm sized nasal defect in nasal tip with cartilage exposure? At first, we can think forehead island flap is most appropriate. We performed 7 cases of the forehead island flap for reconstruction of the defect in nasal tip(4 cases: cancer, 3 cases: trauma) from March, 2001 to August, 2004. This result was satisfactory in the point of texture, color, donor scar, and there were no complication such as wound disruption, infection, flap atrophy, and hematoma. The advantages of forehead island flap are: 1) No injury of deep vessel and nerve, 2) control of shape and volume, 3) Short operation time, 4) primary closure of donor site, 5) one stage operation. Also, forehead island flap can cover the defect in nose where skin graft and local flap can not cover. But, operator always must take care for flap congestion and donor site scar. We thought forehead island flap is one of the best option of reconstruction of nasal tip defect.