• Archives of Plastic Surgery
• /
• 제41권2호
• /
• pp.148-152
• /
• 2014

Background Free flap surgery for head and neck defects has gained popularity as an advanced microvascular surgical technique. The aims of this study are first, to determine whether the known risk factors such as comorbidity, tobacco use, obesity, and radiation increase the complications of a free flap transfer, and second, to identify the incidence of complications in a radial forearm free flap and an anterolateral thigh perforator flap. Methods We reviewed the medical records of patients with head and neck cancer who underwent reconstruction with free flap between May 1994 and May 2012 at our department of plastic and reconstructive surgery. Results The patients included 36 men and 6 women, with a mean age of 59.38 years. The most common primary tumor site was the tongue (38%). The most commonly used free flap was the radial forearm free flap (57%), followed by the anterolateral thigh perforator free flap (22%). There was no occurrence of free flap failure. In this study, risk factors of the patients did not increase the occurrence of complications. In addition, no statistically significant differences in complications were observed between the radial forearm free flap and anterolateral thigh perforator free flap. Conclusions We could conclude that the risk factors of the patient did not increase the complications of a free flap transfer. Therefore, the risk factors of patients are no longer a negative factor for a free flap transfer.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제34권5호
• /
• pp.367-375
• /
• 2012

Midfacial reconstruction following resection of extensive malignant oral cavity tumors constitutes a challenging problems for reconstructive surgeons. Rectus abdominis muscle free flap (RAMFF) can be considered as the optimal reconstructive option in this case, because this flap has some advantages including consistent deep inferior epigastric artery anatomy, easy to dissect with well defined skin boundaries, acceptable donor site morbidity and the ability to perform simultaneous flap harvest with oral cancer ablation surgery. The rectus abdominis muscle forms an important part of the anterior abdominal wall and flexes the vertebral column, which is a long strap-like muscle divided transversely by three tendinous intersections, fibrous bands which are adherent to the anterior rectus sheath, which is thickly enclosed by the rectus sheath, except for the posterior part below the arcuate line that is usually located midway between the umbilicus and symphysis pubis. Below the arcuate line, this muscle lies in direct contact with the transversalis fascia and parietal peritoneum. For the better understanding of RAMFF as a routine reconstructive procedure in oral and maxillofacial surgery, the constant anatomical findings muse be learned and memorized by the young doctors in the course of the special curriculum periods for the Korean national board of oral and maxillofacial surgery. This review article will discuss the anatomical basis of RAMFF with Korean language.

• Korean Journal of Head & Neck Oncology
• /
• 제18권1호
• /
• pp.46-49
• /
• 2002

Background: Free flaps have become a very important role in the ablative head and neck surgery with functional preservation of defect sites. The forearm free flap has many advantage of lack of bulk, ease of dissection, vascularity, and malleability. Patients and Methods: A review of 51 radial forearm free flaps performed between may 1990 and feburary 2001 at the Korea University was undertaken to determine outcome. Patient age ranged 27 to 72 years (mean 56). There were 44 men and 7 women. The most prevalent neoplasm was squamous cell carcinoma. Results: The tans verse cervical artery and the external jugular vein were the most frequent receipient sites for microvascular anastomosis. Total flap loss occurred in 2 cases (4%) and other complications were seen in 42%. Fifteen patients received preoperative irradiation and the complication was higher than non-irradiation patients, but statistically not significant. Conclusion: The radial forearm free flap offers a variety of reconstructive options for head and neck. Its low flap loss and complication rates offer the best choice for reconstruction of defect of head and neck malignancy.

• Archives of Plastic Surgery
• /
• 제40권6호
• /
• pp.761-765
• /
• 2013

Background Partially resecting ribs of the recipient site to facilitate easy anastomosis of the internal mammary vessels to free flaps during breast reconstruction can cause chest wall pain or deformities. To avoid this, the intercostal perforating branches of the internal mammary vessels can be used for anastomosis. The purpose of this study was to investigate the location and size of the internal mammary perforator vessels based on clinical intraoperative findings and to determine their reliability as recipient vessels for breast reconstruction with microsurgical free tissue transfer. Methods Twelve patients were preoperatively screened for the presence of internal mammary perforators using Doppler tracing. After modified radical mastectomy was performed by a general surgeon, the location and size of the internal mammary perforator vessels were microscopically investigated. The external diameter was examined using a vessel-measuring gauge from a mechanical coupling device, and the distance from the mid-sternal line to the perforator was also measured. Results The largest arterial perforator averaged 1.5 mm, and the largest venous perforator averaged 2.2 mm. Perforators emerging from the second intercostal space had the largest average external diameter; the second intercostal space also had the largest number of perforators arising from it. The average distance from the mid-sternal line to the perforator was 20.2 mm. Conclusions Internal mammary perforators presented consistent and reliable anatomy in this study. Based on these results, the internal mammary perforators appear to have a suitable diameter for microvascular anastomosis and should be considered as an alternative recipient vessel to the internal mammary vessel.

• Archives of Plastic Surgery
• /
• 제36권4호
• /
• pp.393-396
• /
• 2009

Purpose: Low - molecular - weight dextran is one of the most frequently used antithrombotic agents in microvascular surgery, but there is controversy if it has the real benefit in the clinical aspects. The purpose of this study was to evaluate the effect associated with postoperative use of low - molecular - weight dextran in breast reconstruction by free TRAM flap patients. Methods: From January 2002 to October 2008, we reconstructed 88 cases of postmastectomy deformity using the free TRAM flap. The 88 cases were divided into two groups : a group with no use of dextran(66 patients, control group, Group A) and a postoperative low - molecular weight dextran loaded group(22 patients, Group B). We assessed number of flap survival, rate of complication like hematoma or seroma, total amount of drainage from operative wound, duration of drainage, and amount of transfusion in each group. Results: There was no total flap loss and every flap was survived. Total amount of drainage for post - operative 5 days were 857 ml in group A and 1101 ml in group B. Drain was kept for average of 7.3 days in group A and 8.7 days in group B. Packed red cell transfusions were made in average of 3.3 units for group A and 3.0 units for group B. Group B showed significantly higher values in former 2 comparative parameters than group A. Conclusion: There was no definitive advantage of anticoagulants in elective free - flap surgery in terms of success rate. However, groups with using anticoagulants had the increased bleeding tendency in immediate postoperative period. The routine use of anticoagulants in elective free - flap surgery should be reconsidered with postoperatively less bleeding and early recovery.

• Archives of Reconstructive Microsurgery
• /
• 제17권2호
• /
• pp.68-74
• /
• 2008

Segmental defects of the tibia after open fractures, sepsis and a tumor surgery are among the most difficult and challenging clinical problems. Tibia defects in these situations are complicated with infection and are resistant to conventional bone grafting techniques. The aim of this study is to report the results and discuss the role of free flap followed by ipsilateral vascularized fibular transposition (IVFT) for reconstruction of tibia defects. Ten patients had free flap followed by IVFT in the period 1989~2007. Mean age was 25.3 years. The patients were followed for an average of 3.4 years. All flaps were survived including 1 case with venous thrombosis requiring additional surgery. The average time to union of proximal and distal end was 5.2 months, 8.2 months, each other. All transposed fibula were viable at last follow-up. IVFT offers the advantages of a vascularized graft. In patients with large bone and soft tissue defects combined with infection, free flap followed by IVFT is an useful and reliable method without microvascular anastomosis.

• Archives of Plastic Surgery
• /
• 제49권1호
• /
• pp.29-33
• /
• 2022

The application of minimal invasive mastectomy has allowed surgeons to perform nipples-paring mastectomy via a shorter, inconspicuous incision under clear vision and with more precise hemostasis. However, it poses new challenges in microsurgical breast reconstruction, such as vascular anastomosis and flap insetting, which are considerably more difficult to perform through the shorter incision on the lateral breast border. We propose an innovative technique of transcutaneous medial fixation sutures to help in flap insetting and creating and maintaining the medial breast border. The sutures are placed after mastectomy and before flap transfer. Three 4-0 nylon suture loops are placed transcutaneously and into the pocket at the markings of the preferred lower medial border of the reconstructed breast. After microvascular anastomosis and temporary shaping of the flap on top of the mastectomy skin, the three corresponding points for the sutures are identified. The three nylon loops are then sutured to the dermis of the corresponding medial point of the flap. The flap is placed into the pocket by a simultaneous gentle pull on the three sutures and a combined lateral push. The stitches are then tied and buried after completion of flap inset.

• Journal of Korean Neurosurgical Society
• /
• 제59권6호
• /
• pp.637-642
• /
• 2016

Objective : Although many treatment modalities have been introduced for trigeminal neuralgia (TN), the long-term clinical results remain unsatisfactory. It has been particularly challenging to determine an appropriate treatment strategy for patients who have responded poorly to initial therapies. We analyzed the surgical outcomes in TN patients who failed prior treatments. Methods : We performed a retrospective analysis of 37 patients with recurrent or persistent TN symptoms who underwent surgery at our hospital between January 2010 and December 2014. Patients with follow-up data of at least one year were included. The prior treatment modalities of the 37 patients included microvascular decompression (MVD), gamma knife radiosurgery (GKRS), and percutaneous procedures such as radiofrequency rhizotomy (RFR), balloon compression, and glycerol rhizotomy (GR). The mean follow-up period was 69.9 months (range : 16-173). The mean interval between the prior treatment and second surgery was 26 months (range : 7-123). We evaluated the surgical outcomes using the Barrow Neurological Institute (BNI) pain intensity scale. Results : Among the 37 recurrent or persistent TN patients, 22 underwent MVD with partial sensory rhizotomy (PSR), 8 received MVD alone, and 7 had PSR alone. Monitoring of the surgical treatment outcomes via the BNI pain intensity scale revealed 8 (21.6%) patients with a score of I, 13 (35.1%) scoring II, 13 (35.1%) scoring III, and 3 (8.2%) scoring IV at the end of the follow-up period. Overall, 91.8% of patients had good surgical outcomes. With regard to postoperative complications, 1 patient had transient cerebrospinal fluid rhinorrhea (2.7%), another had a subdural hematoma (2.7%), and facial sensory changes were noted in 8 (21.1%) patients after surgery. Conclusion : Surgical interventions, such as MVD and PSR, are safe and very effective treatment modalities in TN patients who failed initial or prior treatments. We presume that the combination of MVD with PSR enabled us to obtain good short- and long-term surgical outcomes. Therefore, aggressive surgical treatment should be considered in patients with recurrent TN despite failure of various treatment modalities.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제23권1호
• /
• pp.1-6
• /
• 2001

Purpose : This study was undertaken to observe the occurrence of the vessel aneurysms according to several different methods of microvascular anastomosis. Mterials & methods : Forty Sprague-Dawley rats, weighing $180{\sim}200$ grams, were used for this experiment. The rats were divided into 4 groups. Group 1 (10 rats): The adventitia was trimmed off 5mm from the cut edge each and 20 arterial anastomoses were performed using 8 to 10 interrupted 9-0 polypropylene ($Prolene^{TM}$, Ethicon, U.K.) suture. Group 2 (10 rats): The adventitia was trimmed off as in group 1. Twenty arterial anastomoses were performed using continuous 9-0 polypropylene($Prolene^{TM}$, Ethicon, U.K.) suture. Group 3 (10 rats): The adventitia was stripped only 1mm from the cut edge each but not removed,. Twenty arterial anastomoses were performed using 8 to 10 interrupted 9-0 polypropylene($Prolene^{TM}$, Ethicon, U.K.) suture. Group 4 (10 rats): The adventitia was handled as in group 3. Twenty arterial anastomoses were performed using 9-0 polypropylene($Prolene^{TM}$, Ethicon, U.K.) suture. The arteries of the animals in all groups were explored at 28th days. We examined patency, presence of an aneurysm, other vascular abnormalities and microscopically observed the aneurysms with H&E and Van-Gieson stains. Result : 1. Patency rate was 80% in group 1, 95% in group 2, 85% in group 3 and 90% in group 4, respectively. 2. Aneurysm occurred 20% in group 1, 5% in group 2, 5% in group 3 and 5% in group 4, respectively. 3. There was no other vascular abnormalities in each group. 4. Infection rate was 5% in group 1, 0% in group 2, 20% in group 3 and 15% in group 4, respectively. 5. In the histopathological findings, we observed partially necrotic changes, loss and fragmentation of outer elastic lamella of smooth muscle in media and the proliferation of hyperplastic subintima. A lot of inflammatory cells were infiltrated in hyperplastic intima. Conclusions : On the basis of these observation, we could state that there were little differences in the occurrence of aneurysms according to different anastomotic suture methods.

• Asian Pacific Journal of Cancer Prevention
• /
• 제13권7호
• /
• pp.3379-3383
• /
• 2012

Objective: To investigate uPA and VEGF expression in esophageal cancer and relations with tumorous invasion and metastasis. Methods: Immunohistochemistry was used to detect uPA and VEGF expression in the normal epithelial tissue of esophageal mucosa and cancer tissue and detect CD34 labeled micrangium and analyze the relationships with clinical pathological features and tumor angiogenesis. Results: Positive rates for uPA and VEGF protein expression were significantly greater in esophageal cancer than normal epithelial tissue (P < 0.05), the two being linked (P <0.05). In addition, uPA and VEGF protein expression of the high microvessel density (MVD) group was significantly lower than in the low MVD group (P < 0.05), with relation to clinical pathological staging, differentiation and lymph node metastasis (P < 0.05). Conclusion: In esophageal cancer tissue, uPA and VEGF proteins are overexpressed and promote tumor angiogenesis, indicative of a poor prognosis.