• Archives of Reconstructive Microsurgery
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• v.13 no.1
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• pp.82-85
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• 2004

Flap monitoring is important for flap salvage. Although there are many methods to observe the flap, practical methods mostly used are subjective methods. Recording flap surface temperature is one of the objective methods of flap monitoring. We used an infra-red thermometer to simplify monitoring of the flap temperature. 60 groin flaps of SD rats are used in the experiment. Artificial arterial or venous insufficiency was made and the surface temperature was checked and compared with body temperature. In the results, the temperature of the arterial clamped flaps was lower than that of body and the mean difference was $0.3^{\circ}C$ after 20 minutes of clamping. In the vein-clamped flaps, the mean decrease was $0.4^{\circ}C$ after 30 minutes of clamping. The all difference of the temperature between the flaps and body was statistically significant. Our results suggest that flap monitoring by infra-red thermometer is simple, useful and helpful to evaluate the flap status.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.29 no.6
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• pp.455-459
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• 2003

The Reconstructive techniques of palatal defect are palatal island flap, palatal mucoperiosteal expansion, buccal flap, tongue flap, pushback palatoplasty, free flap and so on. We report a reconstruction of palatal defect using palatal flap. Excellent results were obtained by palatal connective tissue island flap and split thickness pedicle flap. Healing of defect occured rapidly. There were no postoperative complications except dull pain.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.5
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• pp.454-458
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• 2010

Velopharyngeal insufficiency is defined as a status in which nasal cavity and oral cavity can not be sepa-rated when speaking, swallowing by any reason. It has been treated by palatorrhaphy, pharyn-geal flap, local flap, free flap etc. When the size of the defect is small, it can be restored by palatorrhaphy, pharyngeal flap etc. But they are not proper for treatment of the large size of defect. In that case, local flap and free flap are more beneficial. Although large defect can be restored by free flap technique, but it is very complex, time-consuming and may bring about esthetical, functional complications of donor site. Buccinator myomucosal flap is a kind of local flap and reported for the first time by Bozola et al in 1989 and it has become a useful way for reconstruction of large intraoral defect. Authors experienced the use of buccinators myomucosal flap for treating secondary velopharyngeal insufficiency with large soft palate defect and obtained good result. So we report the case with literature reviews.

• Archives of Plastic Surgery
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• v.33 no.2
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• pp.187-192
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• 2006

The perforator flaps are based on cutaneous vessels which are originated from a main pedicle and penetrate fascia or muscle to reach the skin. The lateral lower leg is one of the most suitable areas for harvesting perforator flaps because a number of perforator vessels exist. The authors applied peroneal perforator flaps in nine patients. Five flaps were reverse island flaps based on peroneal artery and septocutaneous perforator, and four flaps were free flap based on musculocutaneous perforator only. The recipient site was the posterior ankle in three patients, posterior heel in three patients, lateral malleolus, anterolateral ankle, and foot dorsum in one patient each. The flap size ranged from 5 to 12cm long, from 3 to 5cm wide, and the primary closure of the donor site was possible in most cases. All flaps, except for the flap in two patients in the reverse island flap series, survived completely. The peroneal perforator flap is a very thin, pliable flap with minimal donor site morbidity and is suitable for the reconstruction of small and medium sized superficial skin defects. Also, this flap may be considered as an alternative to radial forearm flap or other perforator flaps.

• Archives of Plastic Surgery
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• v.47 no.4
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• pp.354-359
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• 2020

The medial sural artery perforator (MSAP) flap is a versatile fasciocutaneous flap that has been used successfully in the reconstruction of defects across the body. In specific cases, it may prove superior to more commonly used options (e.g., anterolateral thigh flap and radial forearm free flap). Historically, a disadvantage of the MSAP flap is the relatively small surface area it provides for reconstruction. We recently encountered a patient with extensive pelvic injuries from prior trauma resulting in significant scarring and contracture of the groin, tethering of the penis, and loss of the scrotum and one testicle. The patient was unable to achieve erection from tethering and his remaining testicle had been buried in the thigh. In considering the reconstructive options, he was not a suitable candidate for a thigh-based or forearm-based flap. An extended MSAP flap measuring 25 cm×10 cm was used for resurfacing of the groin and pelvis as well as for the formation of a neoscrotum. This report is the first to document an MSAP flap utilized for simultaneous groin resurfacing and scrotoplasty. Additionally, the dimensions of this flap make it the largest recorded MSAP flap to date.

• Archives of Reconstructive Microsurgery
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• v.25 no.1
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• pp.15-18
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• 2016

Any types of burn injury that involve more than deep dermis often require reconstructive treatment. In gluteal region, V-Y fasciocutaneous advancement flap is frequently used to cover the defect. However, in case of large burn wounds, this kind of flap cannot provide adequate coverage because of the lack of normal surrounding tissues. We suggest V-Y adipofascial flap using the surrounding superficially damaged tissue. We present the case of a patient who was referred for full-thickness burn on gluteal region. We performed serial debridement and applied vacuum-assisted closure device to defective area as wound preparation for coverage. When healthy granulation tissue grew adequately, we covered the defect with surrounding V-Y adipofascial flap and the raw surface of the flap was then covered with split-thickness skin graft. We think the use of subcutaneous fat as an adipofascial flap to cover the deeper defect adjacent to the flap is an excellent alternative especially in huge defect with uneven depth varying from subcutaneous fat to bone exposure in terms of minimal donor site morbidity and reliability of the flap. Even if the flap was not intact, it was reuse of the adjacent tissue of the injured area, so it is relatively safe and applicable.

• Archives of Reconstructive Microsurgery
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• v.24 no.1
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• pp.24-27
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• 2015

During flap elevation, most perforators are cut except one or more perforators that are essential to flap survival. However these cutout perforators can cause deterioration of the blood circulation of the flap. To salvage the jeopardized flaps, rebuilding the perforator system is essential for flap survival. In the first case, after flap elevation, the upper abdominal flap margin was severely ischemic. To supply blood to the upper abdominal flaps, we found and used a major perforator underneath the upper abdominal flap which was cut earlier during the elevation, and we performed reanastomosis with ipsilateral deep inferior epigastric artery. Upper abdominal flap ischemic area was limited to a narrow suture area. In the second case, we performed free superficial inferior epigastric artery (SIEA) flap reconstruction. After successful anastomosis of the SIEA and superficial inferior epigastric vein (SIEV) with internal mammary artery and vein, serious venous congestion occurred immediately because of SIEV malfunction. We found the largest perforator vein under the flap, as an alternate way to drain, then connected it with the thoracoacromial vein with a vein graft harvested in the contralateral SIEV. Circulation has improved. In conclusion, perforator system reconstruction is essential in a jeopardized flap salvage.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.29 no.1
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• pp.71-78
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• 2007

The nasolabial flap has been used for reconstruction of moderate size intraoral defects. The nasolabial fold area provides an ample supply of tissue with a good color and texture match. The nasolabial flap classified advancement flap, inferiorly-based flap, superiorly-based flap. The flap is based inferiorly, so that it can easily be rotated to the intraoral defects. The nasolabial flap is chosen for the repair of various intraoral defects because of its simple elevation, proximity to the defect and its rich subcutaneous blood supply of a island flap. The subjects were 6 patients with nasolabial flap, who had reconstruction of moderate size intraoral defects. We have found the inferiorly-based nasolabial flap with a subcutaneous pedicle useful in the primary repair of surgical defects of the buccal mucosa, edentulous mandibular ridge, maxillary alveolus area and soft palate in these patients. There was no complication except one case. Intraoral hair growth was a minor problem of this patient. We thought that the inferiorly-based nasolabial flap is a useful technique for reconstruction of various intraoral defects.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.39
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• pp.24.1-24.6
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• 2017

Background: Tunneled transposition of the facial artery myomucosal (FAMM) island flap on the lingual side of the mandible has been reported for intraoral as well as oropharyngeal reconstruction. This modified technique overcomes the limitations of short range and dentition and further confirms the flexibility of the flap. This paper presents a case of reconstructing secondary soft palatal defect due to flap necrosis following two-flap palatoplasty in irradiated patient with lingually transposed facial artery myomucosal island flap. Case presentation: The authors successfully reconstructed secondary soft palatal defect due to flap necrosis following two-flap palatoplasty in an irradiated 59-year-old female patient with tunnelized-facial artery myomucosal island flap (t-FAMMIF). Conclusions: Islanding and tunneling modification extends the versatility of the FAMM flap in the reconstruction of soft palatal defects post tumor excision and even after radiation, giving a great range of rotation and eliminating the need for revision in a second stage procedure. The authors thus highly recommend this versatile flap for the reconstruction of small and medium-sized oral defects.

• Archives of Reconstructive Microsurgery
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• v.7 no.1
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• pp.10-14
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• 1998

When covering a skin defect of the finger with a local flap is difficult, a vascular island flap is often used. For a palmar skin defect, it is desirable to add a sensory supply to the flap. This report describes a neurovascular island flap that was used to repair a palmar skin defect, the donor skin coming from the dorsal region of the middle phalanx. This flap is elevated with a vascular pedicle of the palmar digital artery and its dorsal skin branch, including the dorsal digital veins, palmar digital nerve and its cutaneous branches. The advantage of this flap are that it can be transferred with ease and without any tension. No special manipulation is required under a microscope and operation can be performed under a simple nerve-block. There if little possibility that the flap itself undergoes ischemic change or congestion. The disadvantage of this flap are that a skin graft is required at the donor skin site and one palmar digital aretery is lost. We think that this neurovascular island flap is one of the useful methods for skin defects that are difficult to cover with a local flap.