• Archives of Plastic Surgery
• /
• v.49 no.3
• /
• pp.324-331
• /
• 2022

Prior abdominal liposuction can be viewed as a relative or absolute contraindication to abdominally based autologous breast reconstruction given concerns for damaged perforators and scarring complicating intraoperative dissection. This systematic review aims to explore the outcomes of abdominally based breast reconstruction in patients with a history of abdominal liposuction. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-guided literature search was conducted using PubMed, Scopus, and Web of Science from the earliest available date through June 2020. Deep inferior epigastric perforator, muscle-sparing transverse rectus abdominis musculocutaneous (TRAM), superficial inferior epigastric artery, and pedicled TRAM flaps were included for evaluation. Complications included total or partial flap loss, fat necrosis, seroma, delayed wound healing, and donor site complications. After inclusion criteria were applied, 336 non-duplicate articles were screened, yielding 11 for final review, representing 55 flaps in 43 patients. There was no instance of total flap loss, eight (14.5%) flaps developed partial loss or fat necrosis, three (5.4%) flaps had delayed wound healing, and two (4.6%) patients had donor site complications. Most authors (8/11) utilized some type of preoperative imaging. Doppler ultrasonography was the most used modality, and these patients had the lowest rate of partial flap loss or flap fat necrosis (8%), followed by those without any preoperative imaging (10%). In conclusion, this review supports that patients undergoing abdominally based autologous breast reconstruction with a history of abdominal liposuction are not at an increased risk of flap or donor site complications. Although preoperative imaging was common, it did not reliably decrease complications. Further prospective studies are needed to address the role of imaging in improving outcomes.

• Archives of Plastic Surgery
• /
• v.38 no.1
• /
• pp.27-34
• /
• 2011

Purpose: Anterolateral thigh (ALT) perforator free flap is commonly used because of its various benefits. The author reports important factors of preoperative and perioperative ALT perforator free flap and causes of failure. Methods: 84 patients who were treated with ALT perforator free flap from December 2004 to 2008, and February 2010 to April 2010 were studied. 61 patients were male and 23 were female. The mean age of patients was 51.1. The main cause was neoplasm and the main reconstructive areas were head and neck area. The size of flap was various from $3{\times}4$ to $12{\times}18$ cm. 6 patients received split thickness skin graft at donor site. Preoperative angiography was checked to all patients. Results: Among the 84 patients, partial necrosis of flaps occurred in 4 patients because of atherosclerosis, varicose vein, or inattention of patient, etc. And total flap necrosis in 5 patients because of abnormal vessels of recipient area or delay of operation, etc. One case of serous cyst was found as the complication of donor area. Two cases of skin graft on donor site were done because of suspected muscle compartment syndrome, 4 cases of that because of large flap. Septocutaneous perforators were found in 7 cases. The author couldn't find reliable perforator in 3 cases, ipsilateral anteromedial thigh perforator and contralateral ALT perforator and latissimus dorsi musculocutaneous free flap were done instead of ALT. There was no case which needed reoperation because of the impairment of blood supply, and 3 cases were revised by leech because of the burn injury by a lamp or venous congestion. Conclusion: Although ALT perforator free flap is widely used with its various merits, many factors such as preoperative condition of donor or recipient area, morphology of defect and operating time need to consider to prevent flap necrosis. And operators should need careful technique because septocutaneous perforator is uncommon, and musculocutaneous perforator is common but difficult to dissect.

• Archives of Plastic Surgery
• /
• v.36 no.5
• /
• pp.559-564
• /
• 2009

Purpose: Surgical reconstruction of an ischial soft tissue defect presents a challenging problem owing to a high rate of recurrence, especially paraplegic patients. Although various muscle, musculocutaneous and fasciocuta - neous flaps have been used in the reconstruction of ischial soft tissue defect, it is still debated which type of flaps are the best. We had performed a relatively durable adductor magnus perforator island flap based on the perforators originated from the first medial branch of the profunda femoris artery for coverage of ischial soft tissue defect where was not a region universally reconstructed by perforator flap. Methods: From August 2005 until January 2008, the adductor magnus perforator island flap had been used for resurfacing of the ischial soft tissue defects in a series of 6 patients (4 male and 2 female). Ages ranged from 26 to 67 years (mean, 47.5 years), and follow - up period from 13 to 26 months (mean, 16.7 months). Causes were 4 pressure ulcers, 1 cellulitis and 1 suppurative keratinous cyst. Results: The sizes of these flaps ranged from 12 to 18 cm in length and 7 to 9 cm in width. The flaps survived in all patients. Marginal loss over the distal area of the flap by infection was noted in one patient, which was treated successfully with a subsequent split - thickness skin graft. Average thickness of the flap was 0.94 cm, which was more thicker than other perforator flaps. Long term follow - up showed a good flap durability. Conclusion: In planning a reconstructive option of ischial soft tissue defect, the adductor magnus perforator island flap is a relatively large cutaneous flap with a durable thickness. With proper patient selection, careful vascular dissection and postoperative management, we recommend this flap is a good and suitable option for coverage of the ischial soft tissue defect.

• Archives of Reconstructive Microsurgery
• /
• v.8 no.1
• /
• pp.71-76
• /
• 1999

Until recently, the cranial base tumors were deemed unresectable due to the inability to diagnose the extent of the involvement accurately and to approach and excise the tumor safely. With refinements in CT and NMR scanning and development of craniofacial techniques, reconstruction becomes absolutely crucial in allowing successful resection of these tumors. Resection of these tumors may sometimes result in massive and complex extirpation defects that are not amendable to local tissue closure. In such cases, the free tissue transfer was a useful alternative because it can provide large amount of well-vascularized tissues and reliable separation of intracranial space from bacterial flora of the upper airway. The microvascular free tissue transfer was used in 9 patients at our center to reconstruct the cranial base defects. Of these, 8 were free rectus muscle flaps, and 1 was free latissimua dorsi muscle flap. There were 1 case of partial flap loss and 1 case of postoperative wound infection. The large, complex defects were successfully reconstructed by one stage operation and the functional and aesthetic results were satisfactory with acceptable complication rates.

• Journal of Chest Surgery
• /
• v.45 no.2
• /
• pp.127-130
• /
• 2012

Sternal dehiscence is one of the most troublesome complications following cardiac surgery. Treatment failure and consequent lethal results are very common, even with all the efforts to resolve sternal dehiscence such as removal of infectious tissue, muscle flap interposition, and sternal rewiring. We report on a case of sternal osteomyelitis following coronary artery bypass grafting that was successfully treated with wide sternal resection, titanium plate fixation, and pectoralis muscle flap interposition.

• Archives of Plastic Surgery
• /
• v.49 no.3
• /
• pp.373-377
• /
• 2022

Currently, robot-assisted latissimus dorsi muscle flap (RLDF) surgery is used in treating patients with Poland syndrome and for breast reconstruction. However, conventional RLDF surgery has several inherent issues. We resolved the existing problems of the conventional system by introducing the da Vinci single-port system in patients with Poland syndrome. Overall, three patients underwent RLDF surgery using the da Vinci single-port system with gas insufflation. In the female patient, after performing RLDF with silicone implant, augmentation mammoplasty was also performed on the contralateral side. Both surgeries were performed as single-port robotic-assisted surgery through the transaxillary approach. The mean operating time was 449 (335-480) minutes; 8.67 (4-14) minutes were required for docking and 59 (52-67) minutes for robotic dissection and LD harvesting. No patients had perioperative complication and postoperative problems related to gas inflation. The single-port robot-assisted surgical system overcomes the drawbacks of previous robotic surgery in patients with Poland syndrome, significantly shortens the procedure time of robotic surgery, has superior cosmetic outcomes in a surgical scar, and improves the operator's convenience. Furthermore, concurrent application to another surgery demonstrates the possibility in the broad application of the robotic single-port surgical system.

• Archives of Craniofacial Surgery
• /
• v.11 no.2
• /
• pp.95-98
• /
• 2010

Purpose: CSF (Cerebrospinal fluid) leakage is the most common complication of neurosurgery. Early management with conservative care or surgery must be followed appropriately due to the increased risk of lethal complications, such as meningitis. We report a case of intractable CSF leakage that occurred after a cerebellar tumor resection, which was treated successfully. Methods: A 53-year old male consulted our department for continuous CSF leakage for 3 months after having received conservative care and lumbar drainage. CSF collection was observed in the dead space of the posterior fossa after a cerebellar tumor resection and postoperative radiotherapy. Using a free latissimus dorsi muscle flap, the dead space within the skull was filled and the defects were covered successfully. Results: At 6 weeks after surgery, the follow-up MRI and CT revealed proper coverage and filling in the area where cerebellar tumor had been removed. No CSF leakage was observed at the postoperative 3 month follow-up. Conclusion: Recurrent CSF leakage was treated after cerebellar tumor resection with a relatively satisfactory result. In terms of the patient's treatment, much better results can be achieved by performing dead space filling using a flap with a sufficient size, in addition to coverage of the defects of the dura.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.42 no.5
• /
• pp.265-270
• /
• 2016

Objectives: To gain information on anatomical variation in anterolateral thigh (ALT) flaps in a series of clinical cases, with special focus on perforators and pedicles, for potential use in reconstruction of oral and maxillofacial soft tissue defects. Materials and Methods: Eight patients who underwent microvascular reconstructive surgery with ALT free flaps after ablative surgery for oral cancer were included. The number of perforators included in cutaneous flaps, location of perforators (septocutaneous or musculocutaneous), and the course of vascular pedicles were intraoperatively investigated. Results: Four cases with a single perforator and four cases with multiple perforators were included in the ALT flap designed along the line from anterior superior iliac spine to patella. Three cases had perforators running the septum between the vastus lateralis and rectus femoris muscle (septocutaneous type), and five cases had perforators running in the vastus lateralis muscle (musculocutaneous type). Regarding the course of vascular pedicles, five cases were derived from the descending branch of the lateral circumflex femoral artery (type I), and three cases were from the transverse branch (type II). Conclusion: Anatomical variation affecting the distribution of perforators and the course of pedicles might prevent use of an ALT free flap in various reconstruction cases. However, these issues can be overcome with an understanding of anatomical variation and meticulous surgical dissection. ALT free flaps are considered reliable options for reconstruction of soft tissue defects of the oral and maxillofacial area.

• Archives of Plastic Surgery
• /
• v.33 no.2
• /
• pp.181-186
• /
• 2006

Myocutaneous flaps have improved the management of soft tissue defects on buttocks and lower extremity. However, there are several inherent disadvantages of muscle flaps such as functional deficits of the donor sites and the bulkiness at the recipient site. To overcome these disadvantages, we have used perforator-based fasciocutaneous rotation flaps for reconstruction of the buttock and lower extremity defects. From March 2003 to February 2005, we have treated 14 patients using perforator-based fasciocutaneous rotation flaps. 10 flaps were based on perforators of the gluteus maximus muscle, and 4 flaps were nourished by perforators from the tibialis anterior and posterior system. The mean postoperative follow-up period was about 1 year. The technique involves localization of the flap perforators preoperatively with a Doppler. The flaps were elevated superficial to the fascia with preservation of one to three perforators. The donor site is then closed primarily. All flaps completely survived and there was no perioperative complications. There was no functional disability of the donor area with esthetically pleasing results. Perforator-based fasciocutaneous rotation flaps for the reconstruction of buttock and lower extremity defects are excellent alternatives to musculocutaeous flaps. The vascularity of the flaps is robust and dissection is technically easy. Perforator flaps do not require sacrificing muscles, but provide sufficient volume and are durable Furthermore, these flaps result in less scar formation and allow more liberal dissection with safety. We conclude that perforator-based fasciocutaneous rotation flaps are very useful for reconstruction of the buttock and lower extremity.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.39
• /
• pp.12.1-12.5
• /
• 2017

Background: Rehabilitation of normal function and form is essential in cleft lip repair. In 2005, Dr. David M. Fisher introduced an innovative method, named "an anatomical subunit approximation technique" in unilateral cleft lip repair. According to this method, circumferential incision along the columella on cleft side of the medial flap is continued to the planned top of the Cupid's bow in straight manner, which runs parallel to the unaffected philtral ridge. Usually, small inlet incision is needed to lengthen the medial flap. On lateral flap, small triangle just above the cutaneous roll is used to prevent unesthetic shortening of upper lip. This allows better continuity of the Cupid's bow and ideal distribution of tension. Case presentation: As a modification to original method, orbicularis oris muscle overlapping suture is applied to make the elevated philtral ridge. Concomitant primary rhinoplasty also results in good esthetic outcome with symmetric nostrils and correction of alar web. As satisfactory results were obtained in three incomplete and one complete unilateral cleft lip patients, indicating Fisher's method can be useful in cleft lip surgery with functional and esthetic outcome. Conclusions: Clinically applied Fisher's method in unilateral cleft lip patients proved the effectiveness in improving the esthetic results with good symmetry. This method also applied with primary rhinoplasty.