• Archives of Craniofacial Surgery
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• v.12 no.1
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• pp.48-52
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• 2011

Purpose: Many advances have been made in lower eyelid reconstruction surgical procedures after tumor ablative therapy. These include skin grafts, local flaps, free flaps, and skin expansion. When a full-thickness defect of the lower eyelid is reconstructed with many free flaps, ectropion and deformity of the medial and lateral canthal areas are common late complications caused by gravitational descent. The radial forearm free flap is widely used because of its lack of bulk, ease of dissection, malleability, and hairlessness. This report introduces a novel method for preventing ectropion using a composite radial forearm free flap reconstruction and palmaris longus suspension technique. Methods: A 70-year-old man had a malignant melanoma on his left lower eyelid. The patient was referred to our department after a biopsy confirmed the initial diagnosis. A full-thickness wide resection with a 25 mm free margin was performed, and a $5{\times}8cm$ radial forearm flap was elevated with a vascularised palmaris longus tendon. The palmaris longus tendon was fixed to the medial and lateral orbital rim perisoteum and the deep temporal fascia. The buccal mucosa was grafted to reconstruct the inner conjunctival layer. The pedicle vessels were anastomosed to the left superficial temporal artery and vein. Results: The postoperative clinical course was uneventful. The flap showed good texture and color match. No ectropion was noted 14 months after surgery and the tumor did not recur. The patient was quite satisfied with the final outcomes. Conclusion: Use of a radial forearm free flap and the palmaris longus tendon is an effective method for a full-thickness lower eyelid reconstruction.

• Archives of Reconstructive Microsurgery
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• v.12 no.2
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• pp.99-104
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• 2003

Liposuction is a useful method for debulking free flap. Recently, ultrasound assisted liposuction(UAL) has been reported to have many advantages over conventional suction-assisted lipectomy. We applied the UAL to debulk free fasciocutaneous flap of the forehead and lower extremities. The result was satisfactory and there was no significant complications worth noting. Although the cost can be expensive, it has many advantages such as less blood loss, larger amount of fat aspirate and better skin contraction. We can conclude that UAL can be a useful alternative method to debulk free fasciocutaneous flap.

• Archives of Plastic Surgery
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• v.32 no.6
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• pp.757-759
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• 2005

Acquired defects involving exposed bone on the forehead is challenging to reconstruct. Skin expansion provides an ideal thin flap for forehead aesthetic unit, but it takes long time and high cost, and many patients are dissatisfied at their figures. Free flap can provide enough tissue immediately, but it takes long time and has the risk of mismatches of color and texture. This report details our experiences with two patients who had soft tissue defect on their forehead that was covered with remnant forehead flap unit. This method uses one-unit-forehead island flap based on supratrochlear and supraorbital vessel. We obtained satisfactory results in terms of aesthetic and functional consideration.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.31 no.6
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• pp.526-530
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• 2009

Recently, the anterolateral thigh(ALT) flap, based on the septocutaneous vessels or musculocutaneous perforators from the descending branch of the lateral circumflex femoral artery has gained popularity in head and neck soft-tissue reconstruction. It has some advantages in free-flap surgery with respect to the radial forearm free flap, such as low donor site morbidity, availability of different tissues with large amounts of skin, adaptability as a sensate or flow-through flap (with the possibility of harvesting a long pedicle with a suitable vessel diameter). Moreover, the thickness of the flap is adjustable until the subdermal fat level, allowing it to be used as a thin or ultrathin flap. This clinical cases are ALT free flap reconstructions without functional impairment of the donor limbs (transitory and permanent) based on anastomosis with superficial temporal arteries and veins in patient of huge resection defect on face, lip and tongue.

• Archives of Reconstructive Microsurgery
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• v.8 no.2
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• pp.163-169
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• 1999

Purpose : To evaluate the efficacy of free musculocutaneous flap in the treatment of chronic osteomyelitis with drain sinus. Materials and Methods : Eighteen patients (sixteen male and two female) whose average age was 42.6 years were followed for an average of 3.5 years after free musculocutaneous flap for chronic osteomyelitis with drain sinus tract. The period of time between the initial injury and this procedure was average 10.6 years. The patients had an average of 4.1 prior surgical procedure before it. Results : Sixteen(88.9%) of the eighteen free musculocutaneous flap survived, including thirteen of latisimus dorsi flap, three of scapular free flap with muscle, two of medial plantar flap with abductor muscle. Sixteen cases had no evidence of recurrence at follow up. Conclusion : Free musculocutaneous flap is an extremely successful and reliable procedure for the treatment of chronic osteomyelitis with drain sinus. This flap with microvascular anastomses is highly vascularized through its own intrinsic blood vessels, which has the advantage of obliterating dead space and providing improved vascularity to the relatively ischemic recipient site and covering the skin defect.

• Archives of Reconstructive Microsurgery
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• v.14 no.2
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• pp.144-151
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• 2005

Purpose: Disaster as traffic accident, industrial disaster, high voltage electrical bum and flame burn of extremity have a destructive effect because of the involvement of deep structure. Generally, such injury may result in decreased function or loss of limb. In this study the successful use of the combined scapular/parascapular flap as microsurgical transfer to cover extensive defect of electrical and flame bum is reported. Material and Method: Between January 2000 and June 2001, the combined scapular and parascapular flap was used for the coverage of soft tissue defect for 7 patients were admitted to our department with high voltage electrical bum and flame burn. The recipient site were the wrist joint in 2 cases, the forearm in 1 case, the ankle joint in 1 case, the foot dorsum in 1 case, the heel in 1 case. Result: Flap survival was complete in all patients. The result of flap coverage for these deep wound was successful. Conclusion: The advantages of scapular/parascapular combined flap were coverage of the large defect, easy shaping of the flap to fit the required three dimensional configuration around the joint, non hair bearing skin of uniform thickness, minimal donor site morbidity.

• Archives of Plastic Surgery
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• v.49 no.5
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• pp.663-667
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• 2022

Finger dorsum defects are a challenging situation. Many reconstruction methods are used in these defects. Extended reverse dorsal metacarpal artery (RDMA) flap is used in dorsal finger reconstruction. Venous congestion in this flap is most important cause of flap failure. In this case, we presented a case in which we used heparin cream due to development of venous congestion in our patient who underwent an extended RDMA flap. A 24-year-old female patient presented to the emergency department with a defect of dorsal of left-hand fourth finger. Defect was covered with an extended RDMA flap. On postoperative first day, venous congestion was observed, and heparin cream was applied three times a day on flap. The signs of venous congestion were regressed. Tissue healed as a result of superficial epidermolysis and skin grafting. No functional limitation was observed in sixth-month postoperative control. Venous congestion is the most important cause of flap failure of extended RDMA flaps. Generally, subcutaneous heparin administration and leech therapy are used. In our case, heparin was applied as a cream instead of subcutaneously, and flap healing was observed as a result of superficial epidermolysis. Heparin cream application can also be used as a treatment option in flaps with venous congestion.

• Archives of Reconstructive Microsurgery
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• v.6 no.1
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• pp.47-55
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• 1997

One hundred and thirty-seven patients had reconstructive surgery of injured feet with microsurgical technique in the Department of Orthopaedic Surgery at Yonsei University College of Medicine from 1983 to 1997. The results were as follows: 1. There were 89 cases in men and 48 cases in women, who together had a mean age of 21.3 years. 2. The causes of injuries were 97 cases from traffic accidents, 15 cases from burns, 11 cases from machinery injury, 5 cases from infection, 2 cases from falling, 2 cases from glass injury, 2 cases from snake bite, 2 cases from explosive injury, and 1 case from ulceration. 3. There were 47 cases with inguinal flaps, 36 cases with scapular flaps, 36 cases with parascapular flaps, 7 cases with deltoid flaps, 4 cases with lateral thigh flaps, 3 cases with latissimus dorsi flaps, 2 cases with tensor fascia lata flaps, and 2 cases with dorsalis pedis flaps. 4. One hundred and twenty-seven(92.7%) cases were successful in reconstructive surgery with microsurgical technique. 5. Functionally, the thick skin flap or sensory flap has less ulceration and good protective sensation. We considered that the function and cosmetic appearance were excellent after reconstructive surgery of the injured feet with microsurgical reconstructive technique and that the thick skin flap or sensory flap has less ulceration and good protective sensation.

• Archives of Reconstructive Microsurgery
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• v.12 no.1
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• pp.30-37
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• 2003

We used bipedicled scapular osteocutaneous free flap for total maxillectomy defect reconstruction in 3 cases of malignant maxillary tumor. We elevated two flaps of the skin paddle and the bone flap with one common pedicle - the subscapular artery - which was devided to the angular branch of the thoracodorsal artery and the circumflex scapular artery to reconstruct the nasal cavity, the palate and the zygoma. The angle between the two flaps was free enough so that we could transfer the two flaps through a single microanastomosis. After the operation, patients could swallow and pronounce well, and the wound contracture was minimal so that we could get aesthetically good result.

• Archives of Plastic Surgery
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• v.45 no.4
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• pp.375-378
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• 2018

In this report, we present a case of successful treatment of a bowel fistula in the open abdomen by perforator flaps and an aponeurosis plug. A 70-year-old man underwent total gastrectomy and developed anastomotic leakage and dehiscence of the abdominal wound a week later. He was dependent upon extracorporeal membrane oxygenation, continuous hemodiafiltration, and a respirator. Bowel fluids contaminated the open abdomen. Two months after the gastric operation, a plastic surgery team, in consultation with general surgeons, performed perforator flaps on both sides and constructed, as it were, a bridge of skin sealing the orifice of the fistula. The aponeurosis of the external oblique muscle was elevated with the flap to be used as a plug. The perforators of the flaps were identified on preoperative and intraoperative ultrasonography. This modality allowed us to locate the perforators precisely and to evaluate the perforators by assessing their diameters and performing a waveform analysis. The contamination decreased dramatically afterwards. The bare areas were gradually covered by skin grafts. The fistula was closed completely 18 days after the perforator flap. An ultrasound-guided perforator flap with an aponeurosis plug can be an option for patients suffering from an open abdomen with a bowel fistula.