• Archives of Plastic Surgery
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• v.50 no.4
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• pp.331-334
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• 2023

Historically, the approach to any reconstructive challenge, whether intentionally or intuitively, can be seen to follow distinct guidelines that could aptly be called "reconstructive metaphors." These have been intended to inform us as to the "what, "when" and "where" this attempt can best be achieved. Yet the "how" or means to accomplish this goal, usually also intuitively well understood, in a similar vein can now be expressed to be within our "reconstructive toolbox." The latter will distinctly mirror our individuality and contain not only the various hardware that we deem essential, but also the means to access whatever technology we may be comfortable with. No toolbox, even if overflowing will ever be full, as potential options and the diversity they represent surely approaches infinity. But the truly excellent reconstructive surgeon will know when their toolbox is in any way lacking, and fears not remedying that deficiency even if the talents of another colleague must be sought, so as always to ensure that the patient will obtain the best appropriate treatment!

• Archives of Plastic Surgery
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• v.50 no.1
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• pp.130-140
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• 2023

Microsurgery, which deservedly sits on top of the reconstruction ladder, has been a boon to plastic surgery. It is because of this marvelous tool that plastic surgeons the world over have been able to tackle many reconstructive dilemmas, which were once considered to be an improbability. Microsurgery-aided revolutions have rendered a new meaning to all forms of reconstruction-whether it is postoncological, posttraumatic, or postlymphedema reconstruction. As the most advanced reconstructive medium at our disposal that has broadened the horizons of plastic surgery exponentially, it is but obvious that many budding plastic surgeons are drawn toward this subspecialty. In lieu of the aforementioned facts, it is necessary to sensitize all such aspiring surgeons about the various intricacies concerning the field of microsurgery. This article with its focus on the six desirable microsurgical attributes of "Clarity, Curiosity, Perseverance, Passion, An Open Mindset and Action," is meant to be a modest attempt on part of the authors to share their microsurgical insights, procured through their respective journeys, with budding aspirants, hoping to sensitize as well as motivate them for the challenging path that lies ahead.

• Archives of Plastic Surgery
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• v.46 no.6
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• pp.589-593
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• 2019

Post-traumatic defects of the distal third of the leg often require skipping a few steps of the well-established reconstructive ladder, due to the limited local reliable reconstructive options. In rare cases, the reconstructive plan and flap choice may encounter challenges when the patient has psychiatric illness affecting compliance with postoperative care. We describe a case of a patient with severe intellectual disability and an open fracture of the distal lower limb. After fracture management and debridement of devitalized tissues, the resultant soft tissue defect was covered with a free gracilis flap. On postoperative day 7, the patient ripped out the newly transplanted flap. The flap was too traumatized for salvage, so a contralateral free gracilis muscle flap was used. The patient showed good aesthetic and functional outcomes at a 1-year follow-up. When planning the postoperative management of patients with psychiatric illness, less complex and more robust procedures may be preferred over a long and complex surgical reconstruction requiring good compliance with postoperative care. The medical team should be aware of the risk of postoperative collapse, focus on the prevention of pain, and be wary of drug interactions. Whenever necessary, free tissue transfer should be performed despite potential compliance issues.

• Archives of Plastic Surgery
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• v.34 no.5
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• pp.605-610
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• 2007

Purpose: Facial trauma is increasing along with increasing popularity in sports, and increasing exposure to crimes or traffic accidents. Compared to the 3D CT of 1990s, the latest CT has made significant improvement thus resulting in higher accuracy of diagnosis. The objective of this study is to compare 64 channel 3 dimensional volume CT(3D VCT) with conventional 3D CT in the diagnosis and treatment of facial bone fractures. Methods: 45 patients with facial trauma were examined by 3D VCT from Jan. 2006 to Feb. 2007. 64 channel 3D VCT which consists of 64 detectors produce axial images of 0.625 mm slice and it scans 175 mm per second. These images are transformed into 3 dimensional image using software Rapidia 2.8. The axial image is reconstructed into 3 dimensional image by volume rendering method. The image is also reconstructed into coronal or sagittal image by multiplanar reformatting method. Results: Contrasting to the previous 3D CT which formulates 3D images by taking axial images of 1-2 mm, 64 channel 3D VCT takes 0.625 mm thin axial images to obtain full images without definite step ladder appearance. 64 channel 3D VCT is effective in diagnosis of thin linear bone fracture, depth and degree of fracture deviation. Conclusion: In its expense and speed, 3D VCT is superior to conventional 3D CT. Owing to its ability to reconstruct full images regardless of the direction using 2 times higher resolution power and 4 times higher speed of the previous 3D CT, 3D VCT allows for accurate evaluation of the exact site and deviation of fine fractures.