• Archives of Reconstructive Microsurgery
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• 제15권2호
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• pp.92-100
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• 2006

Radial forearm free flap (RFFF) has been established itself as a versatile and widely used method for reconstruction of the head and neck, although it is still criticized for high mortality of donor site. Delayed wound healing, cosmetic deformity, vascular compromise and potentially reduced wrist function have many plastic surgeons hesitate to adapt it as a first choice in micro-reconstruction. To overcome these drawbacks, some techniques for donor-site repair such as V-Y advancement with full thickness skin graft (FTSG), application of artificial dermis ($Terudermis^{(R)}$) or acellular dermal matrix ($AlloDerm^{(R)}$), and double-opposing rhomboid transposition flap have been reported. Authors performed 4 cases of RFFF in old-aged patients of the head and neck cancer from April 2005 to February 2006. We compared the outcomes of donor site of RFFF which were resurfaced with split thickness skin graft (STSG) only and STSG overlying an $AlloDerm^{(R)}$. Patients were all males ranging from 59 to 74 years old (mean, 67.5). Three of them had tongue cancers, and the other showed hypopharyngeal cancer. All cases were pathologically confirmed as squamous cell carcinomas. We included the deep fascia into the flap, so called subfascially elevated RFFF in three cases, and in the other one, we dissected the RFFF suprafascially leaving the fascia intact. The donor site of the suprafascially elevated RFFF was resurfaced with STSG only. Among three of subfascially elevated RFFFs, donor-sites were covered with thin STSG only in one case, and STSG overlying $AlloDerm^{(R)}$ in two cases. All RFFFs were survived completely without any complication. The donor site of the suprafascially elevated RFFF was taken well with STSG only. But, the partial graft loss exposing brachioradialis and flexor carpi radialis muscle was unavoidable in all the subfascially elevated RFFFs irregardless of $AlloDerm^{(R)}$ application. Considering that many patients of the head and neck cancer are in old ages, we believe the RFFF is still a useful and versatile choice for resurfacing the head and neck region after cancer ablation. Its reliability and functional characteristics could override its criticism for donor site in old-aged cancer patients.

• Archives of Plastic Surgery
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• 제36권5호
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• pp.578-582
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• 2009

Purpose: In extensive deep burn of the lower limb, due to less amount of soft tissue, bone is easily exposed. When it happens, natural healing or reconstruction with skin graft only is not easy. Local flap is difficult to success, because adjacent skins are burnt or skin grafted tissues. Muscle flap or free flap are also limited and has high failure rate due to deep tissue damage. The authors acquired good outcome by performing one - stage operation on bone exposed soft tissue defect with AlloDerm$^{(R)}$(LifeCell, USA), an acellular dermal matrix producted from cadaveric skin. Methods: We studied 14 bone exposed soft tissue defect patients from March 2002 to March 2009. Average age, sex, cause of burn, location of wound, duration of admission period, and postoperative complications were studied. We removed bony cortex with burring, until conforming pinpoint bone bleeding. Then rehydrated AlloDerm$^{(R)}$(25 / 1000 inches, meshed type) was applicated on wound, and thin split thickness(6 ~ 8 / 1000 inches) skin graft was done at the immediately same operative time. Results: Average age of patients was 53.6 years(25 years ~ 80 years, SD = 16.8), and 13 patients were male(male : female = 13 : 1). Flame burn was the largest number. (Flame burn 6, electric burn 3, contact burn 4, and scalding burn 1). Tibia(8) was the most affected site. (tibia 8, toe 4, malleolus 1, and metatarsal bone 1). Thin STSC with AlloDerm$^{(R)}$ took without additional surgery in 12 of 14 patients. Partial graft loss was shown on four cases. Two cases were small in size under $1{\times}1cm$, easily healed with simple dressing, and other two cases needed additional surgery. But in case of additional surgery, granulation tissue has easily formed, and simple patch graft on AlloDerm$^{(R)}$ was enough. Average duration of admission period of patients without additional surgery was 15 days(13 ~ 19 days). Conclusion: AlloDerm$^{(R)}$ and thin split thickness skin graft give us an advantage in short surgery time and less limitations in donor site than flap surgery. Postoperative scar is less than in conventional skin graft because of more firm restoration of dermal structure with AlloDerm$^{(R)}$. We propose that AlloDerm$^{(R)}$ and thin split thickness skin graft could be a solution to bone exposured soft tissue defects in extensive deep burned patients on lower extremities, especially when adjacent tissue cannot be used for flap due to extensive burn.

• Archives of Plastic Surgery
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• 제36권5호
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• pp.629-636
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• 2009

Purposes: Wide scars occurring on the lower face and neck are a source of both functional and esthetic problems. Consequently, we can use skin grafts, pedicled flaps, free flaps, and tissue expansion for the reconstruction of this area. Compared with other reconstruction techniques, tissue expansion is advantageous in that it enables the maintenance of a color and texture similar to that of the adjacent tissue. However, the conventional method of tissue expansion has been reported to lead to an unnatural cervicomental angle and to the deformity of adjacent structures. We have therefore made efforts to prevent these problems through the use of several operative procedures. Methods: Forty-one patients with lower facial and cervical scars underwent tissue expansion. The tissue expansion was performed using a rectangular-shaped Nagosil$^{(R)}$ tissue expansion device. On insertion of the tissue expander, the intermediate area of superficial fat layer was dissected and then the tissue expander was inserted to make a flap that was as thin as possible. In advancement of the flap, a capsule-formed by the tissue expander-was used for the interrupted fixed suture of the flap to the fascia of the platysma muscle of the neck. This procedure was performed multiple times and also performed between the flap and the periosteum of the mandible, such that the tension was removed during the suture of the flap margin. Finally, the patients were fitted with a Jobst$^{(R)}$ facial garment in order to stabilize the operation site at least twelve months. Results: The most prevalent location of the scar was the cheek (15 cases), followed by the chin in 14 cases and the neck in 12 cases. The mean size of scar was $55.7{\pm}39.4cm^2$. Conclusions: Using our procedures, we have experienced no significant deformities and have also achieved a more natural cervicomental angle in the patients.

• Journal of Veterinary Clinics
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• 제30권5호
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• pp.371-375
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• 2013

An 11 year-old intact female Yorkshire Terrier weighing 3.5 kg was presented with the complain of having a perineal mass, fecal incontinence and tenesmus. Physical examination revealed reducible bilateral ventral perineal mass, enlarged mammary gland and vaginal discharge. Bilateral ventral perineal hernia (BVPH) and pyometra were diagnosed based on the clinical and radiographic findings. Ovariohysterectomy was performed after general anaesthesia to treat pyometra. The BVPH was repaired by herniorrhaphy with semitendinosus muscle transposition along with colopexy and cystopexy. The postoperative radiographs and CT revealed a good correction of the BVPH. The patient showed good activity after 10 days and no complications were observed during a one year follow up period. BVPH can be successfully surgically managed by herniorrhaphy with semitendinosus muscle transposition along with cystopexy and colopexy in the dog.

• Journal of Chest Surgery
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• 제25권6호
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• pp.630-636
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• 1992

From August 1990 through December 1991, 14 patients[all males] underwent int-rathoracic muscle transposition of extrathoracic skeletal muscles to treat empyemas, 6 patients had tuberculous empyemas, 4 had chronic empyemas of unknown etiology, 3 had pos-tpneumonectomy empyemas, and 1 had postlobectomy empyema. 9 patients had associated bronchopleural fistulas, Their ages ranged from 22 to 67 years, with mean age of 45.1$\pm$17. 6[$\pm$S.D] years. The serratus anterior was transposed in 13 patients, the latissimus dorsi in 12. In 11 patients, both the serratus anterior and the latissimus dorsi were transposed. The omental flap also transposed in 3 patients. To reduce the dead space in the thoracic cavity, thr-oacoplasty was also carried out in 10 patients. The number of the partially resected ribs was 3.0$\pm$0.8[$\pm$S.D.]. All operations were single stage procedures, and all wounds were closed primarily, with no permanent tubes or chest wall openings. There was no hospital mortality, and so no subsequent operation has been required. Follow-up of the patients ranged from 5 to 16 months with a mean of 9.2$\pm$3.1[$\pm$S.D] months, All the patints had no further signs or symptoms of the original infection after discharge. We conclude that intrathoracic transposition of extrathoracic skeletal muscle is an excellent method of treatment for persistent, life-threatening intrathoracic infections.

• Journal of Chest Surgery
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• 제34권9호
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• pp.729-732
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• 2001

A 49-year-old male patient was admitted with chief complaint of hemoptysis. Preoperative chest PA and CT scan revealed air-filled large cavitary lesion at the right upper lobe with typical meniscus sign. Serum anti-fungus antibody for Aspergillus was positive and he was diagnosed as aspergilloma. We planned RULobectomy but it was impossible due to severe pleural adhesion in apex and mediastinal pleura. Therefore, we performed a cavernostomy and serratus anterior muscle flap transposition in one stage. The patient recovered without complication and was followed up for 8 months without recurrence of hemoptysis.

• Annals of Clinical Neurophysiology
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• 제8권2호
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• pp.171-173
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• 2006

Marcus Gunn jaw winking phenomenon has been thought to result from a congenitally abnormal innervation of the levator palpaebrae muscle by a branch of the trigeminal nerve. A 22-year old man presented with bilateral eyelid elevation on the chewing or eating since infancy. Neurological examination showed bilateral Marcus Gunn Jaw wingking phenomenon in this patient. We referred this patient to the department of ophthalmology and plastic surgery for levator resection or orbicularis oculi muscle flap. We report bilateral Marcus Gunn jaw winking phenomenon, although unilateral disorder is the most common form of trigemino-oculomotor synkinesis. Neurologists should be aware of this phenomenon for decision of proper management and take detailed neurologic examination for elucidating the association of other cranial nerves.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제27권3호
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• pp.226-237
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• 2005

Purpose : Extensive defect of oral and maxillofacial area is usually reconstructed with composite flap including skin paddle. However, if the defects are lined with only skin components, the mucosa's role in mastication and texture are not restored. Furthermore, stiffness and hair-growing prevent denture rehabilitation and good oral hygiene. This study was performed to overcome the disadvantages of composite soft tissue flaps including the skin and to make a model for myo-mucosal flaps. Materials and methods : Buccal mucosa sized $0.5\times1.0\;cm^2$ from New Zealand rabbit (around 1.5kg) was harvested and cultivated by the modification of Rheinwald and Green's keratinocyte culture method. Cultured mucosa was grafted on the fascia of latismus dorsi as form of mucosal sheet. After 7, 10, 14 days, the myomucosal flap was excised and evaluated under light microscope with H & E and immunohistochemical staining. As control group, harvested buccal mucosa from rabbit was transplanted to gracilis muscle(n=6). Results : From 7 days after prelamination, the basal layer of the grafted mucosa resembled that of normal mucosa. As control group, transplanted mucosa had original shape but there's slight inflammatory reaction. Prelaminated mucosa has 19.8$\pm$4.59 cell layers and some samples have more than 20 layers. The expression rate of PCNA was relatively strong (42.9%$\pm$14.1) at the basal layer of grafted mucosa and the laminin was found at the basal layer. On the contrary, prelaminated mucosa at 10 days showed moderate expression rate of PCNA(32.4%$\pm$4.62). We found the mucosal layer was somehow disappeared and there is strong inflammatory reaction. After 14 days prelamination, the grafted oral keratinocytes were almost disappeared and expression of PCNA was not observed. Conclusion : We can make 75 fold large mucosal($3850mm^2$) sheet from small samples of mucosa $(50mm^2)$. Epithelial sheet that grafted on the fascia of muscle underwent differentiation and proliferation. But after 10, 14 days, there was strong inflammatory reaction and the grafted mucosa was destroyed from surface layer. In rabbit model, transfer of fascio-mucosal flap should be done from 7 to 10 days after prelamination.

• Korean Journal of Head & Neck Oncology
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• 제9권1호
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• pp.3-9
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• 1993

The benficial effects for perfusion in the preservation of free flaps have been controversial in the clinical and experimental field until now. This study was undertaken to observe the effect of UW solution. a recently developed. high molecular weight. organ perfusion solution. for protection of ischemic injury in normothermic free myocutaneous flaps. Forty rabbits were used in this sutdy. A 1x2x1cm sized gastrocnemius myocutaneous flap based on the feeding vessel from common femoral artery was made. The author set up the ischemic time for 12 hours in these flaps. The flap was washed out with normal saline(control grop, n=10), urokinase(comparative group I, n=10), UW solution before ischemic time(comparative group II, n=10) and UW solution before ischemic time and pentoxifylline before reperfusion(comparative group III, n=10). Afterthen, reperfusion was made for 12 hours. After this procedure, we checked the degree of ischemia and necrosis of myocutaneous flap by gross finding, electrical stimulation test of muscle, triphenyltetrazolium chloride staining and wet/dry weight ratio. The degree of necrosis of comparative group II and III were lesser than control and urokinase group in gross finding(p<0.05). In the electrical stimulation test of muscle, there was no statistical difference between control($1.76{\pm}1.01$) and urokinase($2.36{\pm}\1.02$) group however the muscular power of comparative group II($3.54{\pm}0.93$) and III($3.49{\pm}1.37gm/mm^2$) demonstrated significantly higher than control group(p<0.05). The ischemic findings were found in seven cases of control group and three cases of urokinase group but there were no ischemic findings in comparative group II and III in TIC stain(p<0.05). In the wet/dry weight ratio of flaps in order to evaluate the tissue edema. there was no statistical difference between control($4.55{\pm}0.29$) and III($3.75{\pm}0.48$) were scored significantly lesser than control and urokinase group (p<0.05). These results suggest that perfusion washout with UW solution improves the viability of normothermic free myocutaneous flap by inhibition of cellular swelling.

• Journal of the korean academy of Pediatric Dentistry
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• 제31권4호
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• pp.665-670
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• 2004

The mandibular buccal frenum becomes a problem when its attachment is too close to the marginal gingival. Heavy buccal frenum mucogingivally results in insufficient attached gingiva, inadequate vestibular depth and also difficulty in eruption of mandibular premolar. The aim of this study is to demonstrate the effectiveness of apically positioned partial-thickness flap as adequate method in order to remove heavy buccal frenum and expose impacted teeth. The author presents the case of a 12-year-old boy. He had problems that was prolonged eruption of #34, #35 due to high pull buccal frenum. After space regaining for normal eruption of #34, #35, we performed apically positioned partial-thickness flap on #34, 35 area. As a results, we confirmed that eruption of #34, #35 has been processed normally And vestibular depth, position of buccal frenum and width of attached gingival was within a normal range. Decrease in muscle pull, adequate width of attached gingiva and increased vestibular depth can be expected from this treatment.