• Archives of Plastic Surgery
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• v.32 no.4
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• pp.408-415
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• 2005

Following a transverse rectus abdominis musculocutaneous(TRAM) flap breast reconstruction, denervated state of the flap causes the flap skin prone to thermal injury, calling for special attention. During the last 5 years, 69 breast reconstruction with 72 free TRAM flaps, were performed. Four out of thesse 69 patients sustained burn injury. Heat sources were a warm bag(n=2), heating pad(n=1) and warming light (n=1). The thermal injuries occured from 2 days to 3 months following the reconstruction. Three patients healed with conservative treatment, but one patient required debridement and skin graft. Initially 3 out of 4 patients with the burn had shown superficial 2nd degree burn with small blebs or bullae. However all 4 patients healed with scars. Mechanism of burn injuries of the denervated flap are known to be resulting from; 1) loss of behavioral protection due to denervation of flap with flap elevation and transfer, 2) loss of autonomic thermoregulatory control with heat dissipation on skin flap vasculature contributing to susceptibility of burn injury. 3) changes of immunologic and normal inflammatory response increasing thromboxane, and a fall in substance P & NGF (nerve growth factor). Including the abdominal flap donor site, sensory recovery of the reconstructed breast varies individually from 6 month even to 5 years postoperatively. During this period, wound healing is delayed, resulting in easier scarring compared to that observed in the sensate skin. Patients should be carefully informed and warned of possible burn injuries and taught to avoid exposure to heat source at least until 3 years postoperatively.

• Archives of Plastic Surgery
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• v.32 no.4
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• pp.403-407
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• 2005

Following a transverse rectus abdominis musculocutaneous(TRAM) flap breast reconstruction, denervated state of the flap causes the flap skin prone to thermal injury, calling for special attention. During the last 5 years, 69 breast reconstruction with 72 free TRAM flaps, were performed. Four out of thesse 69 patients sustained burn injury. Heat sources were a warm bag(n=2), heating pad(n=1) and warming light (n=1). The thermal injuries occured from 2 days to 3 months following the reconstruction. Three patients healed with conservative treatment, but one patient required debridement and skin graft. Initially 3 out of 4 patients with the burn had shown superficial 2nd degree burn with small blebs or bullae. However all 4 patients healed with scars. Mechanism of burn injuries of the denervated flap are known to be resulting from; 1) loss of behavioral protection due to denervation of flap with flap elevation and transfer, 2) loss of autonomic thermoregulatory control with heat dissipation on skin flap vasculature contributing to susceptibility of burn injury. 3) changes of immunologic and normal inflammatory response increasing thromboxane, and a fall in substance P & NGF (nerve growth factor). Including the abdominal flap donor site, sensory recovery of the reconstructed breast varies individually from 6 month even to 5 years postoperatively. During this period, wound healing is delayed, resulting in easier scarring compared to that observed in the sensate skin. Patients should be carefully informed and warned of possible burn injuries and taught to avoid exposure to heat source at least until 3 years postoperatively.

• Archives of Reconstructive Microsurgery
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• v.22 no.1
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• pp.24-28
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• 2013

Purpose: Soft tissue defect of the hand, which cannot be covered with skin graft or local flap, is usually reconstructed using a free flap. Temporoparietal fascial free flap is one of the best alternatives for functional reconstruction of the hand with exposed tendons, bones, and joints. Materials and Methods: We have experienced four cases of reconstruction using a temporoparietal fascial flap with a skin graft and followed up for 20 years. We conducted a retrospective review of the patients' clinical charts and photos. Results: At the time of initial injury, the average age of patients was 50.3 (39~62) years. The radial artery was used for reconstruction of the dorsal side of the hand, whereas the ulnar artery was used for that of the volar side of the wrist. Short term complication such as skin graft loss and donor site alopecia occurred. However, during the long term follow-up period, no change of flap volume was noted, and full range of motion in the adjacent joint was maintained. In addition, hyperpigmentation of the grafted skin on the flap disappeared gradually. Conclusion: Selection of the optimal flap is important for reconstruction of the hand without functional limitation. We obtained satisfactory soft tissue coverage and functional outcomes using a temporoparietal fascial free flap and followed up for 20 years.

• Biomedical Science Letters
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• v.25 no.3
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• pp.282-287
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• 2019

Skin flap necrosis remains a major complication of reconstructive surgery. Euterpe oleracea Mart., popularly known as "acai berry" contains hydroxybenzoic acid, antioxidant polyphenolics and anthocyanins. These and other compounds within the acai berry confer anti-inflammatory and anti-oxidative effects. In this current study, we evaluated the protective effect of acai berry extracts on survival of random-pattern skin flaps in a murine model by histologic analysis. ICR mice were subjected to skin elevation surgery and orally administered acai berry extract (100 mg/kg) daily for 7 days. Tissues were stained with hematoxylin-eosin or Masson's trichrome to observe tissue integrity and collagen deposition. In addition, $TGF-{\beta}$ and VEGF was stained by immunofluorescence to determine anti-inflammatory cell infiltration and neovascularization, respectively. We found a decrease in inflammatory cell infiltration and increase in collagen deposition in the acai berry extract treated mice compared to control mice. Immunofluorescence staining reveal a higher number of $TGF-{\beta}$ positive cells and enhanced VEGF staining in the acai berry extract treated mice. The results from this study indicate that oral uptake of acai berry extract can promote healing and survival of surgical skin flaps in mice providing an augmentative therapeutic approach to enhancing skin flap survival.

• Journal of Korean Neurosurgical Society
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• v.43 no.1
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• pp.51-53
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• 2008

The syndrome of the sinking skin flap was introduced to explain the phenomenon of neurological deterioration after decompressive craniectomy. A 37-year-old man was admitted with acute subdural hematoma and traumatic intraparenchymal hematoma. After decompressive craniectomy, the patient suffered from hydrocephalus for which a ventriculoperitoneal (V-P) shunt was inserted. Following this procedure, the depression of the skin flap became remarkable and his mentation was deteriorated. The patient recovered uneventfully after temporary elevating of valve pressure and cranioplasty. We present a patient who was successfully managed with elevation of valve pressure and cranioplasty for the syndrome of the sinking scalp flap with review of a pertinent literature.

• Archives of Reconstructive Microsurgery
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• v.8 no.2
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• pp.149-153
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• 1999

Purpose : To investigate the complication of donor site in latissimus dorsi muscle flap. Materials and Methods : From April 1983 to March 1999, forty patients with latissimus dorsi muscle flap for reconstruction of extremity and with a follow-up period of more than 12 months were included. We analysed the complication, shoulder function, degree of shoulder muscle weakness, skin scar width after operation. Results After 1 year, skin scar widening in 12 cases(30%), limitation of shoulder motion in 9 cases(12.5%), muscle weakness in 14 cases(17.5%) were found. Conclusion. The rate of complication at donor site after latissimus dorsi flap operation is around 10%. To minimize the complication, avoiding axillary skin incision, minimal invasive harvesting by endoscopy, meticulous suturing of subcutaneous layer are needed.

• Journal of Acupuncture Research
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• v.29 no.4
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• pp.105-111
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• 2012

Objectives : An objective measurement for the effects of acupuncture therapy had been regarded as one of the important agendas in the research of acupuncture. This case report aimed to measure the changes of blood flow on the skin flap after one session of electroacupuncture treatment. Methods : A 27-year-old male patient was treated with ipsilateral or contralateral electroacupuncture on the $LI_{11}$, $LU_{10}$, $LI_{10}$, $TE_5$, $SI_3$ and Ex- $UE_9$(Palsa) in the arm with the skin flap on dorsal region of the hand. Changes of blood perfusion on the skin flap and opposite dorsum of hand were measured with laser Doppler blood perfusion imager(LDPI). Results : Immediate post-treatment relative changes of the blood perfusion on the skin flap and opposite hand after one session of ipsilateral electroacupuncture was 21% and 18% higher than values from pre-treatment assessment, respectively. On the contrary, when needled contralaterally, relative changes of the blood perfusion on the affected and unaffected hand was 7% lower and 22% higher than values from pre-treatment assessment, respectively. Mean differences of the blood perfusion between on the skin flap and on control hand remained similar after the ipsilateral acupuncture treatment but substantially increased(44.58 of perfusion units). Conclusions : Electroacupuncture may alter the local blood flow on the skin flap. More study is needed to investigate the effects of acupuncture on the blood flow and microcirculation on the skin tissue by well-designed clinical and experimental studies.

• Journal of Biomedical Engineering Research
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• v.42 no.1
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• pp.25-30
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• 2021

Objective: The aim of this study is to consider the effect of skin tissue necrosis by improving blood flow in animal skin models for low frequency pulsed electromagnetic fields (LF_PEMF) stimulation. Methods: Twenty rats (Wistar EPM-1 male, 280-320 g) were randomly divided into control groups (n=10) and the PEMF groups (n=10). To induce necrosis of the skin tissue, skin flap was treated in the back of the rat, followed by isolation film and skin flap suturing. Subsequently, the degree of necrosis of the skin tissue was observed for 7 days. The control group did not perform any stimulation after the procedure. For the PEMF group, LF_PEMF (1 Hz, 10 mT) was stimulated in the skin flap area, for 30 minutes a day and 7 days. Cross-polarization images were acquired at the site and skin tissue necrosis patterns were analyzed. Results: In the control group, skin tissue necrosis progressed rapidly over time. In the PEMF group, skin tissue necrosis was slower than the control group. In particular, no further skin tissue necrosis progress on the day 6. Over time, a statistically significant difference from the continuous necrosis progression pattern in the control group was identified (p<0.05). Conclusions: It was confirmed that low frequency pulsed electromagnetic fields (LF_PEMF) stimulation can induce relaxation of skin tissue necrosis.

• Archives of Plastic Surgery
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• v.36 no.6
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• pp.707-713
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• 2009

Purpose: The deep inferior epigastric perforator(DIEP) free flap is well known as an ideal donor site for the breast reconstruction. The flap can provide huge amount of fat tissue for breast and buttock contour, while it is also very useful as a thin skin flap to reconstruct the upper and lower extremities. We used a DIEP free flap in various site reconstructions besides the breast and would like to reinsure the usefulness of this flap. Methods: Twenty nine consecutive patients who underwent DIEP free flap surgery from 2001 January to 2007 December were reviewed. The case constituted seven male patients and twenty two female patients. There were sixteen breast reconstructions, five face reconstructions, five lower extremity reconstructions, two upper extremity reconstructions, and one buttock contour reconstruction. All clinical data were based on the patient's medical records. Results: All DIEP free flaps survived without major complications. There was no hematoma, seroma, or partial necrosis. The donor sites were closed primarily with linear scar on lower abdomen. The thinnest part of flap was 0.7 cm in thickness. The size of the largest flap was $38{\times}13cm$. The flaps were used in various types of skin and adipose tissue, adipose tissue only, and skin only according to the requirement of recipient site. Conclusion: The DIEP free flap was enough to provide a thin and huge flap for both breast and extremity reconstructions. It was able to provide versatile designs with sufficient adipose tissue. So we use it for 3 - dimentional face and buttock contour reconstructions. The DIEP free flap is a valuable reconstructive donor for face, upper and lower extremity in addition to breast without compromising the integrity of abdominal wall.

• Archives of Plastic Surgery
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• v.34 no.4
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• pp.441-447
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• 2007

Purpose: Various kinds of local flap or free flap have been used for coverage for soft tissue defects with bone exposure over the ankle and dorsum of foot. Adipofascial flaps, nourished by vascular plexuses of the subcutaneous tissue and deep fascia originating from the local perforators of the major vessels, appear particularly to be indicated for the reconstruction of these areas. Our experience with this flap on the dorsum of foot and ankle has also been quite encouraging. Methods: The design of the flap is determined by the size and the location of the defect. The base of the flap is chosen depending on the availability of the soft tissue around the defect. The ratio of the area of the flap to the area of the base wound be more reliable to predict the survival of the turnover flap by the conventional length-to-width ratio. Nineteen patients with defect over the dorsum of the foot and ankle were resurfaced with adipofascial turn-over flaps and skin graft. Results: The average age of the patients was 38.2 years(3 - 81 years). The flap size was from $2{\times}3cm$ to $8{\times}5cm$. The average follow-up time was 6 months. All flaps survived completely except one case who suffered distal necrosis of the flap. The additional skin graft was required for partial skin loss in the five cases. Other functional impairment was not noted. Conclusion: Dissection of the local adipofascial turnover flap is quite easy, quick, requires less time and sacrifice of surrounding muscle itself, and maintains major arteries. In most cases, donor-site morbidity is minimal with an acceptable scar, and both functional and esthetical results were satisfactory. Therefore, Adipofascial flap could be an option for the difficult wounds around the foot and ankle.