• Archives of Reconstructive Microsurgery
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• v.8 no.2
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• pp.139-148
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• 1999

Since Nakayama's first report about venous flap, many experimental and clinical studies were done about this new type of flap. And due to its various benefits, its applications as arterialized venous free flap type have increased recently. In this study we have attempted to reconstruct composite of defects of the hand with new modification of arterialized venous free flap and simultaneous reconstruction of skin, nerve, tendon were performed successfully. From 1994 to 1999, the defects of the hands in 35 patients were reconstructed with various modifications of arterialized venous free flaps. The range of age was from 19 to 55 years and size of flap ranged from $1{\times}2cm\;to\;14{\times}9cm$. Among them, 12 cases of flap over 20cm in size were included. Indications of flaps were as follows: resurfacing of the defects of the skin (9 cases), simultaneous reconstruction of extensor, skin and digital nerve(2 cases), reconstruction of the skin with extensor(5 cases), as a flap-through type vascular reconstruction(6 cases), for digital nerve reconstruction(2 cases), contracture release(3 cases), and finger tip reconstruction(9 cases). All of the cases except one survived with marginal skin necrosis less than 10%. And relatively large flaps over 20cm in size successfully survived without any delay procedures. Composite reconstructions including tendon and nerve were successful with new modifications of this flap. Arterialized venous free flap is one of the useful procedure in reconstruction of the hand because it has many advantages such as non-bulky and good quality of flap, variable length of pedicle, preservation of major vascular pedicle, less operation time, single operative field and in addition possibility of various modifications.

• Archives of Plastic Surgery
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• v.46 no.5
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• pp.480-483
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• 2019

Repairing surgical defects of the nose is still challenging due to its tridimensional shape and its aesthetic concern. Difficulty in reconstructing nasal subunits lies in their contour, skin texture and limited availability of adjacent skin. For lower nasal dorsum and supra-tip regions, we design a new combined local flap as existing local flaps may give disappointing results. This combination flap was performed on two patients for reconstruction of the lower nasal dorsum area after basal cell carcinoma excision. Size of the excision ranged from 20 to 25 mm diameter and safe margins were obtained. The defects were reconstructed with a local flap that combined a rotation nasal flank flap and a V-Y advancement nasolabial flap. Excision and reconstruction were performed in a one-stage surgery under intravenous sedation and local anesthesia. There were no postoperative complications and no flap loss occurred. Aesthetic and functional results after 6 months postoperatively were satisfying without modification of nasal shape. This flap is reliable and offers interesting functional and aesthetic outcomes. It can be considered as a new reconstruction alternative for supra-tip and lower nasal dorsum skin defects performed in a one-stage procedure under local anesthesia.

• Korean Journal of Head & Neck Oncology
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• v.31 no.1
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• pp.5-8
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• 2015

Backgrounds: The purpose of this study was to compare full thickness skin graft with inguinal skin to split thickness skin graft for coverage of the radial forearm free flap donor site. Patients and Methods: 25 patients who was reconstructed with radial forearm free flap for head and neck cancer were reviewed retrospectively. Results: The graft loss rates of full thickness skin graft were less than split thickness skin graft or split thickness skin graft with dermal substitutes. The recovery times of donor site and skin graft donor site of full thickness skin graft were also shorter than split thickness skin graft or split thickness skin graft with dermal substitutes. Skin texture and aesthetic results of donor site were improved and complications as itching and pain sensation were decreased. Conclusion: Full thickness skin grafts with inguinal skin should be considered for patients requiring a radial forearm free flap.

• Archives of Reconstructive Microsurgery
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• v.7 no.2
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• pp.122-128
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• 1998

Radial forearm flap is one of the most useful skin flap in hand reconstructuion with distally based reverse pedicled or free vascularized fashion. Athors modified that flap into reverse pedicled and free vascularized flap which has advantages of both methods. The modification composed with harvesting flap on recipient side distal forearm just as free flap, than apply it as reverse distal pedicled flap fashion with microvascular anastomosis with distal vascular stump of donor radial vessels. We underwent this method in 5 cases in finger reconstruction from 1996, all of the cases had sucessful results. The advantages of this method are: 1. Thin flap which is compatible to finger skin can harvest from distal forearm with very long vascular pedicle that can be passed under the subcutaneous tunnel which avoid additional skin incisions on the hand. 2. The vessels of donor site and recipient site are same vessel in effected side of forearm, which can preserve contralateral side forearm and hand keep intact. 3. The flap can cover the defects on distal portion of the fingers which is difficult in conventional reversed radial forearm pedicled flap because of limited mobilization of flap due to limitation of pedicle length reach to tip of the fingers.

• Korean Journal of Head & Neck Oncology
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• v.4 no.1
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• pp.21-28
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• 1988

Skin replacement in large cheek defects after excision of benign or malignant tumor on the face is a challenging task. The physical characteristics of cheek skin are matched best by adjacent skin. Various methods of reconstructing of the facial surface such as forehead flap, distant flap, or a full thickness or split thickness skin graft have replaced adjacent tissue for coverage in many cases. We have reviewed ten cases of aesthetic reconstruction of the face after resection of the facial skin tumor within the last 5 years. The first group of 3 patients were reconstructed with split thickness skin graft from the scalp or lower abdomen. The second group of patients were reconstructed with cheek flap. The third group of 3 patients were reconstructed with cervicofacial flap. The last 2 patients were reconstructed with nasolabial flap & island falp respectively. The advantages from our experience with various method of coverage are its hidden donor area & good color match with the facial skin & increased success rate.

• Archives of Plastic Surgery
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• v.36 no.6
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• pp.767-772
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• 2009

Purpose: Among reasons for reoperations in augmentation mammoplasty, palpable implant, due to thin skin is relatively common, but not easy to correct, especially if thin skin area is wide. The capsule around the implant is a physiologic response to foreign body, naturally formed, and suitable for use as a flap because of its high vascularity. Authors report that capsular flap is very effective and successful method for correction of implant palpability in secondary breast augmentation. Methods: From September 2007 to September 2008, the capular flaps were performed on 5 patients having palpable and wrinkling breast implants due to very thin skin among the cases on whom secondary augmentation mammaplasty had been performed. After the capsular flap was elevated according to thin skin area, the capsular flap was turned down or over to cover the thin skin area and made the thin skin area thick. Results: Post - implant palpable breast wrinkling had been successfully corrected by capsular flaps and breast implants were not palpable any more during the follow - up period(average 9.2 months). All patients who suffered from deformed breast were satisfied. Conclusion: Authors suggest that the capsular flap is a ideal, effective and useful method in management of implant palpability.

• Archives of Reconstructive Microsurgery
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• v.13 no.1
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• pp.24-28
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• 2004

The vascularity of a skin island in fibula osteocutaneous free flap often depends on musculocutaneous perforators that find their origin in the proximal peroneal artery. But a potential drawback has been reported on the unreliability of the skin paddle. The perforating vessels to the skin paddle of the fibula osteocutaneous free flap were rarely derived from a common tibio-fibula trunk, an anterior tibial artery and a posterior tibial artery. Previous studies have emphasized total loss of the overlying skin paddle, if the expected perforating vessels are not present. We report here on our experience that the skin paddle of the fibula osteocutaneous free flap was vascularized not by a peroneal artery but a direct branch of the posterior tibial artery. There were no intraseptal nor intramuscular pedicles in the posterior crural septum which connected to the overlying skin island. Therefore, we performed microsurgical anastomoses between distal peroneal vessels of the fibula and the perforating branches of the posterior tibial vessels of the skin paddle. The anastomosed skin paddle was salvaged with a peroneal flow through vascular anastomosis and was transferred to the bone and intraoral soft tissue defects with the fibula graft. The patient had no evidence of vascular compromise in the postoperative period and showed good healing of the intraoral skin flap.

• Archives of Plastic Surgery
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• v.37 no.5
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• pp.571-576
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• 2010

Purpose: Reconstruction of soft tissue defects of the foot often requires free-flap transfer. Free muscle flap transfer and skin grafts on the muscle has been an option for these defects. Here we present our experiences of foot reconstruction using an endoscopy-assisted free muscle flap harvest. Methods: Using endoscopy-assisted free muscle flap harvests, four patients with soft tissue defects of the foot were treated with a free muscle flap and skin graft. The gracilis muscle was used for two patients and the rectus abdominis muscle for two. A single small transverse skin incision was placed on the lower abdomen for the rectus abdominis muscle. A small transverse skin incision on the proximal thigh was the only incision for harvesting the gracilis muscle flap. The small incisions were enough for the muscle flap to be pulled through. Results: The flaps survived successfully in all cases. Contours were good from both functional and aesthetic aspects. No breakdowns or ulcerations of the flap developed during long-term follow-up. Resultant scars were short and relatively hidden. Functional morbidities such as abdominal bulging were not noted. Conclusion: Endoscopy-assisted harvest of muscle flap and transfer with skin graft is a good option for soft tissue defects of the foot. Morbidities of the donor site can be minimized with endoscopic flap harvest. This method is preferable for young patients who want a small donor site scar.

• Archives of Plastic Surgery
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• v.33 no.6
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• pp.742-747
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• 2006

Purpose: The purpose of this study was to evaluate the role of mast cell and histamine as typical product of mast cell in ischemia-reperfusion injury of muscle flap using H2 receptor blocker and mast cell stabilizer. Methods: Thirty-five Sprague-Dawley rats weighing 250-300 gm were divided into four groups; Group I: Control group without ischemia, Group II: Normal saline injection group with ischemia, Group III: Cimetidine injection group with ischemia, Group IV: Sodium cromoglycate injection group with ischemia. Well established single pedicled transverse rectus abdominis musculocutaneous(TRAM) flap was designed in all rats and were rendered ischemia by clamping the artery for 150 minutes. All injections were applied intramuscular around gluteal area 30 minutes before reperfusion. The flap survival was evaluated at 7 days after operation. Neutrophil counts and mast cell counts were evaluated 24 hours after reperfusion. Results: The difference of skin flap survival between control group and cimetidine injection group was not significant. In the normal saline injection group flap survival was markedly decreased compared to that of control group. The muscle flap survival was similar to the results of skin flap survival. The neutrophil counts were significantly decreased in control group and sodium cromoglycate injection group than normal saline injection group. The mast cell counts were significantly decreased in cimetidine injection group and control group than both normal saline injection and sodium cromoglycate injection groups. The protective effect of sodium cromoglycate was not seen in the skin flap, but the muscle flaps showed protective effects of sodium cromoglycate compared to normal saline injection group. Conclusions: It is suggests that commonly used antihistamine(H2 receptor blocker) has protective effect against ischemia-reperfusion injury to skin and muscle flaps by reducing neutrophil and mast cell. The mast cell stabilizer was not effective for skin flap but, possibly, for muscle flap.

• Korean Journal of Head & Neck Oncology
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• v.11 no.1
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• pp.47-55
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• 1995

A large lateral facial defects especially a through and through defect of the cheek remains as challenging field of reconstruction for the head and neck surgeons. Closure of these wounds is technically troublesome due to the magnitude and location of the soft tissue and skin defect, functional and aesthetic consideration. optimal cancer surveillance, and desire for good nourishment. Most traditional methods dealing with these defects, including split-thickness skin graft, local and regional flaps as well as musculocutaneous flaps have their limitations. We applied four different methods for these reconstruction in four cases. We utilized temporal muscle flap, forearm free flap and secondary healing for repair of mucosal defects, and medial base cervicopectoral flap, pectoralis major myocutaneous flap and cervicofacial flap for the reconstruction of external skin defects. In one case, both sides were reconstructed with single forearm free flap. In our experiences, secondary healing could be one of the useful method for mucosal repair in the defect between upper and lower gingivobuccal sulcus. However, forearm free flap was thought to be more ideal for the cases with mandibulectomy. For the external repair, the regional skin flap was considered to be superior to pectoralis major myocutaneous flap or forearm free flap especially on color matching.