• Maxillofacial Plastic and Reconstructive Surgery
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• v.40
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• pp.25.1-25.4
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• 2018

Background: Some of head and neck cancer patients are in compromised general condition after ablation surgery and chemoradiation therapy, which makes secondary free tissue transfer quite challenging. Elderly cancer patients also have some risk for microvascular surgery with lengthened general anesthesia. In those cases, the pedicled flap vascularized by supraclavicular artery could be considered as an alternative to free flap. Despite several authors have demonstrated the clinical reliability of supraclavicular artery island flap (SCAIF), to date, SCAIF has not been widely used among reconstructive surgeon. In this article, we clarified vascular flow pattern and introduce simple surgical technique of SCAIF with a literature review. Case presentation: Three patients who had underwent previous neck surgery and adjuvant therapy received maxillofacial reconstruction using SCAIF. It required only a few landmarks, flap harvesting was carried out, and the elapsed time gradually decreased to 15 min with experiences. There were no remarkable morbidities in both donor and recipient sites. Conclusion: SCAIF exhibited minimal anatomic variations and short learning curve of surgical techniques, which might be valuable reconstruction modality for beginning surgeon. And it can be beneficial option for the patients with vessel-depleted neck, medically compromised status for lengthened general anesthesia and failed free tissue transfer.

• Advances in aircraft and spacecraft science
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• v.2 no.3
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• pp.329-343
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• 2015

This study aimed to observe the effect of a novel concept (referred to as the flap extension) implemented on the leading edge of the flap of a three element high lift device. The high lift device, consisting of a flap, main element and slat is designed around an Airbus research profile for sufficient take off and landing performance of a large commercial aircraft. The concept is realised on the profile and numerically optimised to achieve an optimum geometry. Two different optimisation approaches based on Genetic Algorithm optimisations are used: a zero order approach which makes simplifying assumptions to achieve an optimised solution: as well as a direct approach which employs an optimisation in ANSYS DesignXplorer using RANS calculations. Both methods converge to different optimised solutions due to simplifying assumptions. The solution to the zero order optimisation showed a decreased stall angle and decreased maximum lift coefficient against angle of attack due to early stall onset at the flap. The DesignXplorer optimised solution matched that of the baseline solution very closely. The concept was seen to increase lift locally at the flap for both optimisation methods.

• Archives of Plastic Surgery
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• v.34 no.2
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• pp.217-221
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• 2007

Purpose: Reconstruction of the soft tissue defect exposing Achilles tendon is a formidable challenge because of the paucity of soft tissue and relatively poor blood supply. This article describes the reconstruction of soft tissue defect exposing Achilles tendon using gracilis muscle free flap and split-thickness skin graft. Methods: From 2000 to 2005, four patients with soft tissue defect exposing Achilles tendon and infection were operated using gracilis muscle free flap and split-thickness skin graft. The defect size ranged from 3.5 to 5cm wide and 6.5 to 8cm long. The mean postoperative follow-up was twenty months. Results: All the flaps were survived without necrosis and infection. We obtained the satisfactory results with good functional and aesthetical outcomes. All cases showed good results with the characteristics of a relatively thin flap without additional debulking procedure. Conclusion: Gracilis muscle free flap with split thickness skin graft could be a good option for reconstruction of soft tissue defect of posterior ankle, exposing Achilles tendon with minimal morbidity of the donor site.

• Archives of Plastic Surgery
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• v.34 no.1
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• pp.60-63
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• 2007

Purpose: Free transverse rectus abdominis musculocutaneous(TRAM) flap is one of the most popular methods of breast reconstruction. But if fat necrosis and fatty induration occur at the reconstructed breast, they can make the breast harder and make it difficult to differentiate a tumor recurrence from them. To expect and prevent these complications, we measured the pressure change of the superficial venous system whose congestion can be the cause of them. Methods: An intraoperative clinical study was done to compare venous pressure of superficial inferior epigastric vein(SIEV) before and after the elevation of free TRAM flap. Fourteen TRAM flaps were included and the pressures of SIEV were measured two times at the beginning of the elevation and just before the division of the inferior pedicle. Results: The venous pressure in free TRAM flap was significantly higher after the flap elevation at both contralateral side and ipsilateral(p=0.005 and p=0.026 respectively). The four cases with vertical scar shower significantly greater increase at contralateral side than ipsilateral side(p=0.020). Conclusion: Intraoperative venous pressure recording can be an objective data for evaluating the congestion of TRAM flap and can help to prevent the complications of fat necrosis and fatty induration with venous superdrainage.

• Journal of Veterinary Clinics
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• v.24 no.3
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• pp.358-366
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• 2007

This study was performed to investigate the application of bovine amniotic membrane for canine corneal ulcer and to compare bovine amniotic membrane flap to nictitating membrane flap. Corneas were treated with 8.0mm trephine and 100% ethanol was applied and corneal epithelium was removed. This experiment was divided into three groups; control group, nictitating membrane flap group and amniotic membrane + nictitating membrane flap group. To compare corneal healing, fluorescein dye test, histopathological examination and TUNEL assay were performed. The healing size of the corneal epithelium in was largest among groups and it was significantly different with the other groups (P<0.05). Also, inflammatory cell deposits and keratocyte apoptosis in amniotic membrane flap group were smallest, but the width of the corneal epithelium was thickest among groups. Therefore, we tentatively predicted that the amniotic membrane flap would be an alternative effective method for the treatment of superficial canine corneal ulcer.

• Transactions of the Korean Society for Noise and Vibration Engineering
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• v.25 no.10
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• pp.667-676
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• 2015

Working displacement variation by elastic deformation of active Gurney flap which was operated on high frequency was observed. Flap-wise natural frequency was lower than mode analysis result and hinge boundary condition was identified to be the cause through the simple modal test. Design modification for increasing natural frequency was conducted for minimizing the elastic deformation at maximum 35 Hz operating condition which was design requirement condition. Brass bushing was applied instead of rotating bearing for gap minimization and Gurney flap design modification was conducted to increase of the flap-wise natural frequency. Design modification effect was validated by natural frequency comparison with mode analysis result and modal test result of design modification model.

• Archives of Reconstructive Microsurgery
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• v.14 no.2
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• pp.131-137
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• 2005

The extensor digitorum brevis (EDB) muscle island flap is a reliable, safe method for coverage of foot and ankle. There are many variation in approach such as curvilinear, zigzag, L-shaped or vertical longitudinal incision for exposure of the EDB muscle. These approaches use only single incision excluding the distal incision for exposure of the distal tendon. Since dorsalis pedis artery vascular bundle and sinus tarsi branch of the lateral tarsal artery both requires careful dissection, single incision alone may cause not only difficulty in exposure but also skin sloughing at donor site. So we tried to modify the approach into two parallel longitudinal incision, one for dorsalis pedis vascular bundle and the other for sinus tarsi branch exposure. The author treated 9 patient with EDB muscle flap. We used single incision in six patients, and two parallel incision in three patients. All the flap survived. In two parallel incision group, dissection was more easy and rapid. So we would like to suggest that two parallel longitudinal incision approach is better method than the single incision technique for exposure of the EDB muscle flap.

• Archives of Reconstructive Microsurgery
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• v.19 no.2
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• pp.88-92
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• 2010

The forefoot reconstruction is a challenging field for plastic surgeons. Weight bearing tolerability and stability are important factor of choosing reconstruction methods, but cosmetic aspect has to be considered. 51 year old man visited our clinic with extensive degloving injury on right forefoot by roller. The soft tissue defect started from metatarsal area to the toe tip including nails. We harvested the anterolateral thigh flap and transferred it to the forefoot defect area with nerve coaptation. The flap was successful without skin necrosis or other complications. Secondary flap debulking surgery was performed after ten months from initial operation. Patient was satisfied with functional and cosmetic outcomes. The patient was able to wear shoes and walk with adequate sensory recovery. As there is few report about reconstruction of forefoot soft tissue defects, we report a unique case of the anterolateral thigh innervated free flap reconstruction in degloving injury.

• Journal of Trauma and Injury
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• v.32 no.3
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• pp.187-193
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• 2019

Many techniques have been developed for reconstruction of the hand; however, less attention has been paid to foot reconstruction techniques. In particular, reconstruction of the forefoot and big toe has been considered a minor procedure despite the importance of these body parts for standing and walking. Most of the weight load on the foot is concentrated on the forefoot and big toe, whereas the other toes have a minor role in weight bearing. Moreover, the forefoot and big toe are important for maintaining balance and supporting the body when changing directions. Recently, attention has been focused on the aesthetic appearance and functional aspects of the body, which are important considerations in the field of reconstructive surgery. In patients for whom flap reconstruction in the forefoot and big toe is planned, clinicians should pay close attention to flap survival as well as functional and cosmetic outcomes of surgery. In particular, it is important to assess the ability of the flap to withstand functional weight bearing and maintain sufficient durability under shearing force. Recovery of protective sensation in the forefoot area can reduce the risk of flap loss and promote rapid rehabilitation and functional recovery. Here, we report our experience with two cases of successful reconstruction of the forefoot and big toe with a sensate anterolateral thigh flap, with a review of the relevant literature.

• Archives of Plastic Surgery
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• v.48 no.2
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• pp.213-216
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• 2021

Many surgeons have demonstrated the validity of sternocleidomastoid muscle flaps for the reconstruction of head and neck tumors. We present a case in which we used an island sternocleidomastoid muscle flap to reconstruct a cheek depression after excision of a malignant parotid tumor. A 44-year-old woman presented with a right malignant parotid tumor. We performed total resection of the parotid gland and facial nerve with the sural nerve and reconstructed the facial nerve and cheek depression with an island sternocleidomastoid muscle flap. The sternal head of the right sternocleidomastoid muscle was cut at the cranial and caudal segments to elevate it as an island flap. We used the superior thyroid artery as the sole pedicle for the island muscle flap. At 1 year and 3 months after the operation, the mimic muscles had gradually recovered and progressed without complications such as Frey syndrome, cervical motor dysfunction, or concave deformation of the neck and cheeks.