• Archives of Craniofacial Surgery
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• v.10 no.1
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• pp.40-43
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• 2009

Purpose: Extensive midface defect following total maxillectomy with orbital exenteration and cheek skin resection should be three dimensionally reconstructed with a large flap that have a sufficient volume of tissue and multiple skin islands. We describe our transverse rectus abdominis myocutaneous(TRAM) free flap with three skin islands which was successfully used in this situation. Methods: A 58-year-old man was performed enbloc total maxillectomy including orbital contents and wide cheek skin because of invasive maxillary squamous cell carcinoma. He was immediately reconstructed with TRAM flap that was designed not vertical but transverse fashion for providing sufficient skin area. Also, deepithelialization procedure making for multiple skin islands was done in flap insetting period when appropriate modification according to the intraoperative situation was possible. Dead space was completely obliterated by bulky muscular tissue, and three skin islands were used for lining of lateral nasal wall, palatal surface, and cheek skin restoration. Results: Postoperative course was satisfying. Maintaining of proper ipsilateral nasal airway, loss of rhinolalia and oronasal regurgitation of food particles, and restoration of cheek contour were successfully obtained. Conclusion: We report clinical experience of threedimensional reconstruction using free TRAM flap after total maxillectomy with orbital exenteration.

• Archives of Craniofacial Surgery
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• v.21 no.1
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• pp.35-40
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• 2020

Background: Extensive eyelid defects are extremely challenging to reconstruct. Although numerous procedures for reconstructing periorbital defects have been proposed, no method is universally used. However, the Tenzel flap is the most commonly used technique to reconstruct eyelid defects affecting one-third to two-thirds of the eyelid. Methods: Recognizing the usefulness of the Tenzel method, we adapted it to reconstruct larger defects around the eyes. Seven patients underwent reconstruction with a modified Tenzel flap with an extended concept after wide excision of a malignant skin lesion. The main difference from the conventional method is that the modified Tenzel flap includes the medial portion of the lower lid defect. The design of a modified Tenzel flap begins as a semicircle at the lateral canthal area, in the same way as a classical Tenzel flap, and extends medially along the subciliary line to cover the defect on the medial lower eyelid. The follow-up time ranged from 3 to 28 months. Results: All flaps survived and healed well, with minimal scarring and natural palpebral outlines. Conclusion: Compared to traditional procedures, the modified Tenzel flap has several advantages, including a one-stage operation, a less noticeable scar, and effective prevention of complications such as lower eyelid ectropion.

• Journal of Dental Anesthesia and Pain Medicine
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• v.18 no.5
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• pp.309-313
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• 2018

Oronasal fistulae (ONF) could remain after surgery in some patients with cleft palate. ONF ultimately requires intraoral surgery, which may lead to perioperative airway obstruction. Tongue flap surgery is a technique used to repair ONF. During the second surgery for performing tongue flap division, the flap transplanted from the tongue dorsum to the palate of the patient acts as an obstacle to airway management, which poses a great challenge for anesthesiologists. In particular, anesthesiologists may face difficulty in airway evaluation and patient cooperation during general anesthesia for tongue flap division surgery in pediatric patients. The authors report a case of airway management using a flexible fiberoptic bronchoscope during general anesthesia for tongue flap division surgery in a 6-year-old child.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.23 no.3
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• pp.212-216
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• 2001

The cervical flap, comprising skin, fascia, and platysma muscle, has significant application in the head and neck region after radical ablative surgery for cancer of the oral cavity. The flap may be used for reconstruction of the cheek, floor of the mouth, and lateral side of the tongue. This flap minimizes donor morbidity by use of cervical operation wound and flap size available is adequate for most oral defects and the procedure is relatively simple and time-saving. However the flap is not applicable in patients where there are large tissue defects and metastasis is suspected. We have used the cervical flap for its rapid, simple, and effective closure of oral defects after cancer ablation and found it is very useful for the reconstruction of relatively small oral defects.

• Proceedings of the Korean Institute of Navigation and Port Research Conference
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• v.29 no.1
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• pp.35-40
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• 2005

Maneuverability of ships has been receiving a great deal of attention both concerning navigation safety and the prediction of ship maneuvering characteristics, to improve it. high-lift device could be applied to design of rudder at design stage. Now, we carried out the flow visualization and investigation of flow field around a flap rudder(trailing-edge flap). Flow visualization results of flap defection shown as the flow around a NACA0020 Flap Rudder will be conducted in a Circulating Water Channel. The purpose of this investigation will be to investigate the development of the separation region on the flap rudder with the variation of the angle of attack and determine the angle of attack at which the flow separates and reattaches.

• Archives of Craniofacial Surgery
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• v.17 no.4
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• pp.240-243
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• 2016

Perfect facial and body symmetry is an important aesthetic concept which is very difficult, if not impossible, to achieve. Yet, facial asymmetries are commonly encountered by plastic and reconstructive surgeons. Here, we present a case of posttraumatic facial asymmetry successfully treated with a unique concept of facial flap repositioning. A 25-year-old male patient visited our department with severe posttraumatic facial asymmetry. There was deviated nasal bone and implant to the right, and the actual facial appearance asymmetry was much more severe compared to the computed tomography, generally shifted to the right. After corrective rhinoplasty, we approached through intraoral incision, and much adhesion from previous surgeries was noted. We meticulously elevated the facial flap of both sides, mainly involving the cheeks. The elevated facial flap was shifted to the left, and after finding the appropriate location, we sutured the middle portion of the flap to the periosteum of anterior nasal spine for fixation. We successfully freed the deviated facial tissues and repositioned it to improve symmetry in a single stage operation. We conclude that facial flap repositioning is an effective technique for patients with multiple operation history, and such method can successfully apply to other body parts with decreased tissue laxity.

• Archives of Reconstructive Microsurgery
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• v.9 no.1
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• pp.44-48
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• 2000

The advent of free bone flaps has made successful replacement of extensive areas of bone loss in the upper and lower extremities. The microvascular free bone flaps have faster healing without bony absorption or atrophy and can heal in the hostile environment of scarred bed or infection. Since the fibula free flap introduced by Taylor and colleague in 1975, it has been used extensively for skeletal reconstruction of extremities. In 1988, the folded vascularized fibula free flap was first described as a technique to reconstruct significant long bone defect of upper and lower extremities. During the same time, the fibular free flap has evolved to become most preferred choice of mandibular reconstruction. Up to present day, few reports have been made on the fibular free flap used for reconstruction of injured hand containing metacarpal bone and soft tissue defect. We present here our new and unique experiences with vascularized fibular osteocutaneous free flap as useful and satisfactory one for reconstruction of hand with composite defects.

• Korean Journal of Cleft Lip And Palate
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• v.12 no.2
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• pp.65-72
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• 2009

Quadrilateral flap technique for primary cheiloplasty in patients with cleft lip was initially developed by Hagedorn in 1884. After Le Mesurier presented this procedure in 1940's, many surgeons adopted this technique for clinical advantage of reconstruction of Cupid's bow and lesser amount of tissue discarding than straight line technique. However, owing to its drawbacks such as sacrifice of Cupid's bow and prominent scar on philtral ridge, other techniques like Tennison's triangular flap and Millard's rotation-advancement flap have gradually taken its place. Nevertheless, some clinicians like Dr. Wang has modified this quadrilateral flap technique for better clinical outcomes. In this report we present 3 cases of unilateral complete cleft lip patients who underwent primary cheiloplasty with favorable outcomes based on Dr. Wang's modified quadrilateral flap technique.

• Korean Journal of Head & Neck Oncology
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• v.18 no.1
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• pp.76-79
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• 2002

Temporoparietal fascial flap (TPFF) has been used in the reconstruction of a broad spectrum of complex defect of head & neck it can be used as pedicled flap or free flap. TPFF is extensively is good for reconstruction of auricular defects because it is fascial flap with ease of covering irregular surface. TPFF is supplied by the superficial temporal artery & vein and innervated by zygomatico-temporal branch of facial nerve and auriculotemporal nerve. The flap ranges from 2-4mm in thickness and can be harvested up to 17x14cm wide, it can include calvarian bone and enables primary closure of donor site. We carried out reconstruction of oral cavity defects by means of TPFF with a satisfactory result in two cases of oral cavity cancer.

• Archives of Reconstructive Microsurgery
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• v.20 no.1
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• pp.64-67
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• 2011

Reconstruction of the distal portion of the great toe has always represented a difficult problem to surgeons. There are many methods of flap reconstruction described for foot defects, but none for tip of the great toe. We report a case of reconstruction of the great toe using a homodigital reverse pedicle island flap method. A 25-year-old man had a crushing injury at the distal phalanx of the left great toe. A homodigital reverse pedicle island flap was raised from the dorso-medial aspect of the proximal phalanx of the great toe based on the distal dorsal arcade. The flap covered the exposed distal phalanx and stump was closed without shortening. He made an uncomplicated recovery and when seen 6 months later he had a good cosmetic and functional result. A homodigital reverse pedicle island flap is described for the reconstruction of the distal part of the great toe. It involves only a single stage procedure with minimal donor site morbidity and provides a good cosmetic results.