• Archives of Reconstructive Microsurgery
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• v.23 no.2
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• pp.76-81
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• 2014

Purpose: Anteromedial surface of the leg is susceptible to trauma, which frequently induces soft tissue defect. When the size of a soft tissue defect is small to moderate, a local muscle flap is an easy and reliable alternative to a free flap. The authors performed medial hemisoleus flaps for reconstruction of soft tissue defects on the anteromedial surface of legs. The aim of this study was to evaluate clinical outcomes and effectiveness of the medial hemisoleus flap. Materials and Methods: Twelve patients underwent the medial hemisoleus flap for reconstruction of a soft tissue defect on the anteromedial surface of the leg from February 2009 to December 2013. There were eight males and four females with a mean age of 47.8 years (15 to 69 years). The mean size of defects was $4.7{\times}4.2cm$ ($2{\times}2$ to $9{\times}6cm$). Flap survival and postoperative complications were evaluated. Results: Mean follow-up period was 39.6 months (7 to 64 months) and all flaps survived. There were two cases of negligible necrosis of distal margin of the flap, which were healed after debridement. All patients were capable of full weight bearing ambulation at the last follow-up. Conclusion: The medial hemisoleus flap is a simple, reliable procedure for treatment of a small to moderate sized soft tissue defect on the anteromedial surface of the leg.

• Archives of Plastic Surgery
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• v.38 no.3
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• pp.235-240
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• 2011

Purpose: Management of pressure sores has been improved, along with development of musculocutaneous flaps and perforator flaps. Nowadays, the treatment of pressure sore with perforator flaps has shown several advantages, including minimal donor site morbidity, relatively versatile flap design not only in primary cases but also in recurred cases and minimized anatomical rearrangement of regional muscle position. In this study, we report our clinical experience of gluteal perforator flap used in the treatment of a greater trochanteric pressure sore. Methods: A clinical study was performed on 7 patients who underwent total 10 operations. 1 superior gluteal artery perforator flap and 9 inferior gluteal artery perforator flaps were used to reconstruct the defect, followed by the mean observation duration of 22 months. Results: There were no total flap loss. We treated 2 cases of partial flap loss with debridement and primary repair. 2 recurred cases were successfully treated using the same method. Donor sites were all primarily repaired. Conclusion: The gluteal perforator flap could be considered as a safe and favorable alternative in the treatment of soft tissue defects in the greater trochanteric area. The advantages of the flap include low donor site morbidity and the possibility of versatile flap design not only in primary cases but also in recurred cases.

• Korean Journal of Head & Neck Oncology
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• v.27 no.1
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• pp.27-31
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• 2011

Purpose : Anterolateral thigh and radial forearm flap is the most important fasciocutaneous flap widely used for reconstruction of tongue. One important purpose of flap is replacing the volume of tongue but still there is no data about the surface area and volume to be reconstructed after glossectomy. In this paper, surface area and volume is estimated from the 3-dimensionally reconstructed MRI images to see which flap is more ideal and to give the reference value for reconstruction. Materials and Methods : With coronal MRI image, tongue including only the intrinsic muscle is delineated in every section and reconstructed 3-dimensionally and calculated the volume and surface area to be reconstructed according to the degree of glossectomy. This volume and surface area was compared with the volume of anterolateral thigh and radial forearm flap. Results : The volume and surface area to be reconstructed in hemiglossectomy was $39.0{\pm}4.0cm^3$ and $31.8{\pm}2.7cm^2$ respectively. The average thickness of anterolateral thigh flap is $9.4{\pm}2.8mm$ and that of radial forearm is $3.8{\pm}1.0mm$. Comparing the curve of tongue surface area and volume with the volume of flap, the anterolateral thigh flap has more ideal volume to replace the defect. Conclusions : The surface area and volume requested for reconstruction could be suggested and the anterolateral thigh flap has more ideal volume for reconstruction of glossectomy defect.

• Archives of Plastic Surgery
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• v.36 no.6
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• pp.714-719
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• 2009

Purpose: Recurrent ischial pressure sore is troublesome for adequate soft tissue coverage, because usually its pocket has a very large deep space and adjacent donor tissue have been scarred in the previous surgery. However, the conventional reconstructive methods are very difficult to overcome them. Modified gluteus maximus myocutaneous V - Y advancement flap from buttock can be successfully used in these circumstances. Methods: From February 2007 to October 2008, modified gluteus maximus myocutaneous V - Y advancement flaps were perfomed in 10 paraplegic patients with recurrent ischial pressure sore. The myocutaneous flap based on the inferior gluteal artery was designed in V - shaped pattern toward the superolateral aspect of buttock and was elevated from adjacent tissue. Furthermore, when additional muscular bulk was required to obliterate dead space, the flap dissection was extended to the inferolateral aspect which can included the adequate amount of the gluteal muscle. After the advanced flap was located in sore pocket, donor defect was repaired primarily. Results: The patients' mean age was 46.9 and the average follow - up period was 12.4 months. The immediate postoperative course was uneventful. But, two patients were treated through readvancement of previous flap due to wound dehiscence or recurrence after 6 months. The long - term results were satisfied in proper soft tissue bulk and low recurrence rate. Conclusions: The modified gluteus maximus myocutaneous V - Y advancement flap may be a reliable method in reconstruction of recurrent ischial pressure sore, which were surrounded by scarred tissue because of its repetitive surgeries and were required to provide sufficient volume of soft tissue to fill the large pocket.

• Archives of Plastic Surgery
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• v.40 no.5
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• pp.575-583
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• 2013

Background The aim of lower-extremity reconstruction has focused on wound coverage and functional recovery. However, there are limitations in the use of a local flap in cases of extensive defects of the lower-extremities. Therefore, free flap is a useful option in lower-extremity reconstruction. Methods We performed a retrospective review of 49 patients (52 cases) who underwent lower-extremity reconstruction at our institution during a 10-year period. In these patients, we evaluated causes and sites of defects, types of flaps, recipient vessels, types of anastomosis, survival rate, and complications. Results There were 42 men and 10 women with a mean age of 32.7 years (range, 3-72 years). The sites of defects included the dorsum of the foot (19), pretibial area (17), ankle (7), heel (5) and other sites (4). The types of free flap included latissimus dorsi muscle flap (10), scapular fascial flap (6), anterolateral thigh flap (6), and other flaps (30). There were four cases of vascular complications, out of which two flaps survived after intervention. The overall survival of the flaps was 96.2% (50/52). There were 19 cases of other complications at recipient sites such as partial graft loss (8), partial flap necrosis (6) and infection (5). However, these complications were not notable and were resolved with skin grafts. Conclusions The free flap is an effective method of lower-extremity reconstruction. Good outcomes can be achieved with complete debridement and the selection of appropriate recipient vessels and flaps according to the recipient site.

• Archives of Reconstructive Microsurgery
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• v.14 no.2
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• pp.95-104
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• 2005

The aim of this study was to investigate the major vascular system to supply flap, flap survival rate and complications after flap elevation in order to evaluate possibility of the vascularized face/scalp allotransplantation. Forty New Zealand white rabbits were divided into two groups: control group and experimental group. Individuals of control group had a face/scalp composite unit which was composed of skin, subcutaneous tissue and platysma muscle, supplying by bilateral facial artery, temporal artery and auricular artery and draining by external jugular vein. After a flap was elevated, bilateral facial artery, temporal artery and auricular artery were ligated. On the other hand, those of experimental group had the same composite unit as control group with bilateral facial artery, temporal artery and auricular artery being not ligated. We had measured survival area of flaps of the sixteen individuals survived for four weeks in the control group and fourteen in the experimental group by Grid method. The mean survival durations of the flap were 3.7days in the control group, 20.0days in the experimental group. The significant differences in the mean survival durations and survival rate at the 28days were found between the control and experimental group (p<0.05). Mean values about the survival area's fractions of all were $1.3{\pm}4.%$ in the control group and $63.1{\pm}4.8%$ in the experimental group. Those of experimental group was significantly higher than control group statistically (p<0.05). The composite face/scalp flap which we have elevated, supplied by bilateral facial artery, temporal artery, auricular artery and drained by external jugular vein has flap viability enough to be transplanted after its elevation.

• Korean Journal of Head & Neck Oncology
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• v.30 no.2
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• pp.115-118
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• 2014

Papillary thyroid carcinoma is known as its relatively high cure rate after surgical treatment. But invasion of the trachea by thyroid carcinoma is poor prognostic factor and the best management is en bloc surgical resection of the tumor invading the trachea. A 55-year-old man was diagnosed as papillary thyroid cancer with tracheal invasion. We treated the patient by total thyroidectomy with window resection of invading trachea followed by immediate reconstruction with sternohyoid muscle flap and tracheostomy. At 48 days after surgery, tracheostoma was closed and the patient had no functional complication by the surgical process. Until 10 months after surgery, there was no sign of recurrence and the patient led social life without any discomfort. We present this case with a review of the related literatures.

• Korean Journal of Bronchoesophagology
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• v.14 no.2
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• pp.57-63
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• 2008

Hypopharyngeal perforation secondary to tracheal intubation is rare, but may result in severe airway complications that include retropharyngeal abscess, pneumothorax, pneumonia, mediastinitis and death. The most common site of hypopharyngeal perforation is the pyriform sinus and the region of the cricopharyngeus muscle. We report a 62-year old man with intubation-induced hypopharyngeal injury presenting as deep neck infection. The patient presented with dyspnea and pain on the neck. Neck CT scan identified fluid and air collection on the neck from the hyoid bone to the thoracic inlet level. Despite of delayed diagnosis, we successfully operated him by using strap muscle myofascial transposition flap. The patient was followed up for 3 months without any complications.

• Archives of Plastic Surgery
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• v.43 no.2
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• pp.197-203
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• 2016

Background The aim of unilateral breast reconstruction after mastectomy is to craft a natural-looking breast with symmetry. The latissimus dorsi (LD) flap with implant is an established technique for this purpose. However, it is challenging to obtain adequate volume and satisfactory aesthetic results using a one-stage operation when considering factors such as muscle atrophy, wound dehiscence and excessive scarring. The two-stage reconstruction addresses these difficulties by using a tissue expander to gradually enlarge the skin pocket which eventually holds an appropriately sized implant. Methods We analyzed nine patients who underwent unilateral two-stage LD reconstruction. In the first stage, an expander was placed along with the LD flap to reconstruct the mastectomy defect, followed by gradual tissue expansion to achieve overexpansion of the skin pocket. The final implant volume was determined by measuring the residual expander volume after aspirating the excess saline. Finally, the expander was replaced with the chosen implant. Results The average volume of tissue expansion was 460 mL. The resultant expansion allowed an implant ranging in volume from 255 to 420 mL to be placed alongside the LD muscle. Seven patients scored less than six on the relative breast retraction assessment formula for breast symmetry, indicating excellent breast symmetry. The remaining two patients scored between six and eight, indicating good symmetry. Conclusions This approach allows the size of the eventual implant to be estimated after the skin pocket has healed completely and the LD muscle has undergone natural atrophy. Optimal reconstruction results were achieved using this approach.

• Korean Journal of Head & Neck Oncology
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• v.37 no.1
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• pp.63-66
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• 2021

Supracricoid partial laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP) or cricohyoidopexy (CHP) involves the removal of the whole thyroid cartilage, both true and false vocal cords, the ventricles, and the paraglottic spaces, sparing the cricoid cartilage, hyoid bone, and at least one functional and mobile cricoarytenoid unit. Reconstruction is performed by suturing of the cricoid cartilage up tightly to the hyoid bone, so trachea-releasing procedures are needed to prevent leakage at anastomosis site. In case of advanced tranglottic cancer invading tracheal tracheal wall, we need to perform additional circumferentrial circumferential tracheal wall resection. However, when we perform SCPL, circumferential resection of tracheal wall is limited because SCPL procedure itself needs releasing of tracheal length. We report a case of advanced transglottic cancer involving tracheal wall treated with induction chemotherapy and SCPL including tracheal wall resection with reconstruction of tracheal defect by sternocleidomastoid muscle flap covered with skin graft.