• 대한두개안면성형외과학회지
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• 제23권3호
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• pp.134-138
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• 2022

The scalp is the thickest skin in the body and protects the intracranial structures. The coverage of a large scalp defect is a difficult surgical procedure, the full details of which must be considered prior to the procedure, such as defect size and depth, and various factors related to the patient's general condition. Although a free flap is the recommended surgical procedure to cover large scalp defects, it is a high-risk operation that is not appropriate for all patients. As such, other surgical options must be explored. We present the case of a patient with an ulcer on the scalp after wide excision and split-thickness skin graft for squamous cell cancer. We successfully performed a reverse temporalis muscle flap for this patient.

• 대한두개안면성형외과학회지
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• 제10권2호
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• pp.97-102
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• 2009

Purpose: To close anterior cranial base, various types of pedicle flaps have been developed previously. However, the results of those pedicle flaps were not constant. To solve such problem, the author designed bipedicle temporalis-pericranial (BTP) flap based on various types of existing flaps and this study intends to introduce this flap and present clinical application case. Methods: The pedicle of the proposed temporalis-pericranial flap is temporalis muscle. The point of this BTP flap is that because of both sides of the unilateral temporalis-pericranial flap are connected by midline pericranial tissue connected with dense vascular network communicate one another locally, that BTP flap can be safely elevated. The case is a 14 months old male patient of frontoethmoidal encephalomeningocele. Surgery was done in a way that after elevating BTP flap and removing encephalomeningocele, BTP flap was moved intracranially, and to prevent cerebrospinal fluid leakage, anterior cranial base was closed. Results: During 1 year and 6 month outpatient tracking observation, no particular finding like CSF leakage, meningitis or hydrocephalus was observed. Conclusion: The benchmarked BTP flap, effective in the treatment of frontoethmoidal encephalomeningocele, is one of the methods to close intracranium and extracranium.

• Archives of Plastic Surgery
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• 제50권4호
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• pp.409-414
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• 2023

The anterior interosseous artery (AIA) perforator flap is not commonly used in hand dorsum reconstruction compared with alternatives. However, it is a versatile flap with several advantages. Literature on the AIA perforator flap is based on the dorsal septocutaneous branch (DSB), which branches from the AIA and passes through fascia between the extensor pollicis longus (EPL) and extensor pollicis brevis muscles. In the described case, the authors reconstructed a hand dorsum defect in a 78-year-old man using an AIA perforator flap with double perforators supplied by the DSB and a new perforator branching from the distal than DSB. No complication was encountered, and the flap survived completely. A retrospective computed tomography review revealed the presence of the new perforator in 14 of 21 patients. Two types of new perforator were observed. One passed through the ulnar side of the extensor indicis proprius (EIP) muscle and penetrated fascia between the extensor digitorum minimi and extensor digitorum communis tendons, whereas the other passed between the EPL and EIP muscles. This report describes the anatomical location and clinical application of the new AIA perforators. The double perforators-based AIA flap provides a straightforward, reliable means of reconstructing hand dorsum defects.

• Archives of Plastic Surgery
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• 제33권4호
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• pp.469-473
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• 2006

Purpose: The transverse rectus abdominis myocutaneous(TRAM) flap has become a reliable method for autogenous breast reconstruction. However, dissection of the tendinous intersections of rectus abdominis is technically difficult. The tendinous intersection has significant vascularity within its fascial layers raising in importance of technique in elevation. If tendinous intersections are damaged during the elevation of the rectus muscle, circulation to TRAM flap can be endangered. The purpose of this study is to evaluate the number of tendinous intersections and to predict anatomical position of the tendinous intersections. Methods: We dissected 182 consecutive TRAM flaps and measured the distance between xiphoid process and each tendinous intersection and evaluated the statistic correlation among the distance, patient's height and position of umbilicus. Results: In this study, in 30.7% of patients, two tendinous intersections were observed in one rectus abdominis muscle, in 67.7% three tendinous intersections, and in 1.6% four tendinous intersections, respectively. But there was no correlation between patient's height and the distance between xiphoid process and each tendinous intersection. Conclusion: It still remains difficult to predict the position of tendinous intersections just by topography before the dissection. Careful and meticulous dissection of the tendinous intersections is still required.

• 대한골관절종양학회지
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• 제13권2호
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• pp.124-129
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• 2007

활막 육종은 수부에서는 드물게 발생하며 광범위 절제술을 요한다. 수부의 광범위 절제술을 시행할 때는 충분한 절제연을 얻어야 하지만 기능적인 면을 고려한 재건술이 요구된다. 저자들은 타병원에서 불완전 병소내 절제술후 전원된, 46세 남자의 우측 수지 무지구근 부위 활막육종에 대해 대능형골 및 제1 중수지골을 포함한 광범위 절제술 후, 비골 이식술과 전외측 대퇴 피판 이식술을 시행하여 재건술을 시행하여 우수한 결과를 얻은 증례를 보고하고자 한다.

• Archives of Plastic Surgery
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• 제32권2호
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• pp.183-188
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• 2005

Defect on the temporal area caused by, surgical ablation of a tumor or an infection should be reconstructed immediately to prevent potentially life-threatening complications such as meningitis and cerebrospinal fluid leakage. The defect on the temporal area usually presents as a typical 'cone-shape'. Successful reconstruction requires sufficient volume of well-vascularized soft tissue to cover the exposed bone and dura. From 1994 through 2003, the authors applied rectus abdominis free flap for the reconstruction of the temporal defect from 1994 through 2003. There were 10 patients with a mean age of 52.1 years. Of these 10 patients, external auditory canal cancer was present in four patients, temporal bone cancer in two, parotid gland cancer in one and three patients were reconstructed after debridement of infection(destructive chronic otitis media). All the free flaps survived, and flap-related complications did not occur. Compared to a local flap, the rectus abdominis free flap can provide sufficient volume of well-vascularized tissue to cover the large defect and can be well-tolerated during an adjuvant radiation therapy. The long and flat muscle can be easily molded to fit in to the 'cone-shape' temporal defect without dead space. It is also preferred because of the low donor site morbidity, a large skin island and an excellent vascular pedicle. Two-team approach without position change is possible. In conclusion, the authors think that rectus abdominis free flap should be considered as one of the most useful method for the reconstruction of a cone-shaped temporal defect.

• Archives of Plastic Surgery
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• 제42권6호
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• pp.783-787
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• 2015

This procedure was developed for preservation of the rectus muscle components and deep inferior epigastric vessel after deep inferior epigastric perforator (DIEP) flap harvesting. A 53-year-old woman with granuloma caused by silicone injection underwent bilateral nipple-sparing mastectomies and immediate reconstruction with "mini-flow-through" DIEP flaps. The flaps were dissected based on the single largest perforator with a short segment of the lateral branch of the deep inferior epigastric vessel that was transected as a free flap for breast reconstruction. The short segments of the donor deep inferior epigastric vessel branch are primarily end-to-end anastomosed to each other. A short T-shaped pedicle mini-flow-through DIEP flap is interposed in the incised recipient's internal mammary vessels with two arterial and four concomitant venous anastomoses. Although it requires multiple vascular anastomoses and a short pedicle for the flap setting, the mini-flow-through DIEP flap provides a large pedicle caliber, enabling safer microsurgical anastomosis and well-vascularized tissue for creating a natural breast without consuming time or compromising the rectus muscle components and vascular flow of both the deep inferior epigastric and internal mammary vessels.

• Archives of Plastic Surgery
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• 제35권1호
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• pp.20-27
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• 2008

Purpose: The anterolateral thigh flap has many advantages over other conventional free flaps. But the anterolateral thigh flap has yet to enter widespread use because perforating arteries exhibit a wide range of anatomic variations and are difficult to dissect when small. The aim of this study is to identify the vascular variability of perforating arteries and pedicle in the anterolateral thigh free flap. Methods: We studied 12 cadavers and dissected 23 thighs. An anterolateral thigh flap ($12{\times}12cm$) was designed and centered at the midpoint of the line drawn from anterior superior iliac spine to the superolateral border of the patella. After we identifed the perforating arteries we dissected up to their origin from lateral circumflex femoral artery along descending branch of lateral circumflex femoral artery. We then investigated the number and the position of perforating arteries, length and diameter of vascular pedicle and pattern of lateral circumflex femoral arterial system. Results: On average $2.3{\pm}1.1$ perforating arteries per thigh were identified. The musculocutaneous perforators were 63.1%. In those perforators five perforators were arose from transverse branch of lateral circumflex femoral artery and two were arose from rectus femoral artery. Most of the perforators were near the intermuscular septum between rectus femoris muscle and vastus lateralis muscle. The length and diameter of pedicle were $11.9{\pm}3.5cm$ and $3.1{\pm}0.8mm$ on average. Conclusion: This study will be helpful for the success in anterolateral thigh free flap.

• Archives of Plastic Surgery
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• 제39권1호
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• pp.3-10
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• 2012

The free muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) and deep inferior epigastric perforator (DIEP) flaps involve transferring skin and subcutaneous tissue from the lower abdominal area and have many features that make them well suited for breast reconstruction. The robust blood supply of the free flap reduces the risk of fat necrosis and also enables aggressive shaping of the flap for breast reconstruction to optimize the aesthetic outcome. In addition, the free MS-TRAM flap and DIEP flap require minimal donor-site sacrifice in most cases. With proper patient selection and safe surgical technique, the free MS-TRAM flap and DIEP flap can transfer the lower abdominal skin and subcutaneous tissue to provide an aesthetically pleasing breast reconstruction with minimal donor-site morbidity.

• 대한두개안면성형외과학회지
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• 제20권2호
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• pp.126-129
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• 2019

Traditionally, a galeal flap has been used for skull base reconstruction. In addition to the galeal flap, several other flaps, such as the temporalis muscle flap or the free vascularized flap, can be options for skull base reconstruction, and each option has advantages and disadvantages. Certain cases, however, can be challengeable in the application of these flaps. We successfully managed to cover a skull base defect using an extended temporalis flap. Herein, we present the case and introduce this novel method.