• Archives of Plastic Surgery
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• v.43 no.6
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• pp.586-589
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• 2016

A pressure sore wound is often extensive or complicated by local infection involving adjacent soft tissue and bone. In this case, a regional flap after simple debridement is not adequate. Here, we present a case of an extensive pressure sore in the sacral area with deep tissue infection. A 43-year-old female patient with a complicated sore with deep tissue infection had a presacral abscess, an iliopsoas abscess, and an epidural abscess in the lumbar spine. After a multidisciplinary approach performed in stages, the infection had subsided and removal of the devitalized tissue was possible. The large soft tissue defect with significant depth was reconstructed with a free latissimus dorsi musculocutaneous flap, which was expected to act as a local barrier from vertical infection and provide tensionless skin coverage upon hip flexion. The extensive sacral sore was treated effectively without complication, and the deep tissue infection completely resolved. There was no evidence of donor site morbidity, and wheelchair ambulation was possible by a month after surgery.

• Journal of Periodontal and Implant Science
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• v.51 no.6
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• pp.398-408
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• 2021

Purpose: In this study, we aimed to evaluate the clinical validity of the modified tunneling technique using minimal soft tissue harvesting and volume-stable collagen matrix in the anterior mandible. Methods: In total, 27 anterior mandibular teeth and palatal donor sites in 17 patients with ≥1 mm of gingival recession (GR) were analyzed before and after root coverage. For the recipient sites, vertical vestibular incisions were made in the interdental area and a subperiosteal tunnel was created with an elevator. After both sides of the marginal gingiva were tied to one another, a prepared connective tissue graft and volume-stable collagen matrix were inserted through the vestibular vertical incision and were fixed with resorbable suture material. The root coverage results of the recipient site were measured at baseline (T₀), 3 weeks (T₃), 12 weeks (T₁₂), and the latest visit (T_l). For palatal donor sites, a free gingival graft from a pre-decided area avoiding the main trunk of the greater palatine artery was harvested using a prefabricated surgical template at a depth of 2 mm after de-epithelization using a rotating bur. In each patient, the clinical and volumetric changes at the donor sites between T₀ and T₃ were measured. Results: During an average follow-up of 14.5 months, teeth with denuded root lengths of 1-3 mm (n=12), 3-6 mm (n=11), and >6 mm (n=2) achieved root coverage of 97.01%±7.65%, 86.70%±5.66%, and 82.53%±1.39%, respectively. Miller classification I (n=12), II (n=10), and III (n=3) teeth showed mean coverage rates of 97.01%±7.65%, 86.91%±5.90%, and 83.19%±1.62%, respectively. At the donor sites, an average defect depth of 1.41 mm (70.5%) recovered in 3 weeks, and the wounds were epithelized completely in all cases. Conclusions: The modified tunneling technique in this study is a promising treatment modality for overcoming GR in the anterior mandible.

• Archives of Plastic Surgery
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• v.36 no.5
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• pp.583-590
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• 2009

Purpose: In the cases of a vascular compromised condition in an injured lower extremity, soft tissue coverage with free tissue transfer presents a challenging problem to the reconstructive surgeon. For this reason, cross - leg flaps are still used in unusual circumstances. Advances in surgical technique has made the cross - leg free flap possible although it may require long operation time along with significant donor site morbidity. Therefore, a pedicled cross - leg muscle flap may be an alternative treatment modality when local flap or free flap is not possible. Methods: Twelve patients(9 males and 3 females) underwent the operation between October of 2001 and December of 2008. The patients' age ranged from 6 to 82 years. The unusual defects included the regions such as the knee, popliteal fossa, distal third of the tibia, dorsal foot, and the heel. Indications for the cross - leg gastrocnemius flap are inadequate recipient vessels for free flap(in eight cases), extensive soft tissue injuries(in three cases) and free flap failure(in one case). The muscle flap was elevated from contralateral leg and transferred to the soft tissue defect on the lower leg while both legs were immobilized with two connected external fixator systems. Delay procedure was performed 2 weeks postoperatively, and detachment was done after the establishment of the adequate circulation. The average period from the initial flap surgery to detachment was 32 days (3 to 6 weeks). Mean follow - up period was 4 years. Results: Stable coverage was achieved in all twelve patients without any flap complications. Donor site had minimal scarring without any functional and cosmetic problems. No severe complications such as deep vein thrombosis or flap necrosis were noted although mild to moderate contracture of the knee and ankle joint developed due to external fixation requiring 3 to 4 weeks of physical treatment. All patients were able to walk without crutches 3 months postoperatively. Conclusion: Although pedicled cross - leg flaps may not substitute free flap surgery, it may be an alternative method of treatment when free flap is not feasible. Using this modification of the gastrocnemius flap we managed to close successfully soft tissue defects in twelve patients without using free tissue transfers.

• Archives of Reconstructive Microsurgery
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• v.3 no.1
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• pp.54-63
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• 1994

Pulp and palm of the hand and heel of the sole are anatomically unique. Satisfactory reconstruction of these areas presents the plastic surgeon with many challenges and requires durable and sensible skin coverage, minimal donor morbidity and reliable operative procedure. We presents 7 clinical cases of sensate instep free flap transfer in this paper during the last 2 years. Three cases were soft tissue defects due to crushing and avulsion injury on the pulp of finger. 1 case was unstable scar and redundant flap after reconstruction of soft tissue dect of palm and 1 case was contracture of first web of hand. One case was a soft tissue defect due to avulsion injury on heel. Lastly, one case was chronic osteomyelitis with open wound on lateral malleolar area. Follow-up period ranged from 3 months to 2 years. Through the whole follow-up period, all flaps were viable and durable to persistant stress or weight bearing and were sensible enough to porotect the recocstructed area from injuries and maintain functions. In conclusions, the instep free flap should be considered as a valuable tool in reconstruction of hand and extremity requiring durability and sensation.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.18 no.2
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• pp.224-235
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• 1996

Early implantation before sufficient ossification has taken place usually results in osseointegartion failure due to reduced bone-fixture interface area. However, various studies have shown successful osseointegration results following immediate implants concurrently with GTR. The clinical trends have been to shorten the patients' edentulous state by immediate implantation, and reduce the alveolar bone resorption. However, it may be difficult to attain the complete soft tissue coverage of the sites, increasing the chance of infection. Furthermore, there may be more studies needed on the clinical behaviors of e-PTFE membranes, various modofications in the membrane materials and bone graft materials. Various animal and clinical studies have been reported on the successful osseointagration following immediate implantation, but the long-term follow-up studies are limited. The present study investigated 16 immediately-implanted implants with GTR therapy with or without calcium carbonate grafting on 11 patients 3 years after installation and 24-30 months after functional loading. Based on the clinical, radiographic and histologic findings, the following results have been attained. 1. Clinically, stability has been shown on all 16 implants throughout the investigated periods. 2. Radiologically, the alveolar bone loss has progressed up to the polished neck portion but not beyond it, suggesting the progressive osseointegration from the GTR therapy. 3. The GTR method used in the present study is easy to use clinically, and may be appied in the regeneration of ossoeous defects around implants and in the immediate implantation. 4. The difficulty in complete tissue coverage may be avoided by delaying the installation for 2 to 3 weeks after the extraction allowing certain degree of soft tissue healing.

• Archives of Reconstructive Microsurgery
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• v.12 no.1
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• pp.19-29
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• 2003

Soft tissue reconstruction of dorsum of the foot and ankle has long presented challenging problems for the reconstructive surgeon. Limitations of available local tissue, the need for specialized tissue, and donor site morbidity restrict the options. In an effort to solve these difficult problems, we have begun to use adipofascial flap based on the perforating branch of the peroneal artery. We present our early experience of 5 patients treated with this flap. Our patients ranged from 6 to 26 years in age and included 3 males and 2 females. The etiologies of the wounds were secondary to traffic accident, and crushing injury. The flaps had reverse flow in all patients. The flap and the adjoining raw area were covered with a full-thickness skin graft, while the donor site at the lateral aspect of the leg was closed primarily without grafting. The skin graft was taken from the inguinal area, which was closed primarily. Compared with other flap, this adipofascial flap is thinner, producing less bulkiness to the recipient site and minor aesthetic sequelae to the donor site. In our opinion, this flap is versatile, effective, and an addition to the armamentarium of the reconstructive surgeon for coverage of difficult wounds of the foot and ankle.

• Archives of Plastic Surgery
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• v.46 no.2
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• pp.176-180
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• 2019

Post-traumatic soft tissue defects sometimes require sequential flap coverage to achieve complete healing. In the era of propeller flaps, which were developed to reduce donor site morbidity, Feng et al. introduced the concept of the free-style puzzle flap, in which a previously harvested flap becomes its own donor site by recycling the perforator. However, when a perforator cannot be found with a Doppler device, we suggest performing a new type of flap, the flip-flap puzzle flap, which combines two concepts: the free-style puzzle flap and the flip-flap flap described by Voche et al. in the 1990s. We present the cases of three patients who achieved complete healing through this procedure.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.47 no.1
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• pp.57-61
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• 2021

Immediate implant placement (IIP) in fresh extraction sockets exhibits similar survival and success rates to delayed implant placement in healed sockets. Several advantages of IIP involve shortened total treatment time, reduction of the number of invasive surgeries, and subsequent reduction of patient discomfort due to lack of additional surgeries. The major shortcomings in IIP, however, include the inability to obtain early bony support, presence of a gap between the extraction socket and fixture, and the inability to cover the fixture with soft tissue, leading to increased risk of infection and implant loss. When IIP is performed, atraumatic or minimally traumatic extractions, conservation of the septal bone in molars, minimal flap elevation or flapless surgery, bone grafting the gap between the fixture and the extraction socket, and coverage with soft tissue or a membrane must be considered.

• Archives of Plastic Surgery
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• v.36 no.6
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• pp.714-719
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• 2009

Purpose: Recurrent ischial pressure sore is troublesome for adequate soft tissue coverage, because usually its pocket has a very large deep space and adjacent donor tissue have been scarred in the previous surgery. However, the conventional reconstructive methods are very difficult to overcome them. Modified gluteus maximus myocutaneous V - Y advancement flap from buttock can be successfully used in these circumstances. Methods: From February 2007 to October 2008, modified gluteus maximus myocutaneous V - Y advancement flaps were perfomed in 10 paraplegic patients with recurrent ischial pressure sore. The myocutaneous flap based on the inferior gluteal artery was designed in V - shaped pattern toward the superolateral aspect of buttock and was elevated from adjacent tissue. Furthermore, when additional muscular bulk was required to obliterate dead space, the flap dissection was extended to the inferolateral aspect which can included the adequate amount of the gluteal muscle. After the advanced flap was located in sore pocket, donor defect was repaired primarily. Results: The patients' mean age was 46.9 and the average follow - up period was 12.4 months. The immediate postoperative course was uneventful. But, two patients were treated through readvancement of previous flap due to wound dehiscence or recurrence after 6 months. The long - term results were satisfied in proper soft tissue bulk and low recurrence rate. Conclusions: The modified gluteus maximus myocutaneous V - Y advancement flap may be a reliable method in reconstruction of recurrent ischial pressure sore, which were surrounded by scarred tissue because of its repetitive surgeries and were required to provide sufficient volume of soft tissue to fill the large pocket.

• Archives of Reconstructive Microsurgery
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• v.11 no.1
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• pp.36-40
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• 2002

Purpose : Our clinical experiences in distally based sural artery island flap is presented to show the usefulness and the reliability as an alternative to flaps currently used for defect in lower extremity. Materials and Methods : From February 1998 to September 2001, nine cases of soft tissue defects in the lower leg, the foot, and around the ankle were treated with distally based sural artery island flap. The cause of the wound was trauma in 6 cases, and osteomyelitis in 3 cases. Defects were located at the lower leg in 2 cases, at the foot in 3 cases and around the ankle in 4 cases. The results were retrospectively analyzed. Results : The defect size ranged from $3{\times}3cm\;to\;20{\times}3cm$. Among 9 cases, 7 cases survived and 2 cases were failed. Flap failure was due to not including the deep fascia in one case and due to extensive soft tissue damage in the other case. Both failed cases were reoperated with the split thickness skin graft. Conclusion : The advantages of distally based sural artery island flap follows (1) reliable blood supply, (2) ease of flap elevation, (3) preservation of the major arteries, (4) less donor site morbidity. Owing to the advantages of this flap, we think it is useful for the soft tissue coverage of the lower leg, the foot and around the ankle. Also we believe it will continue to gain acceptance and use in the majority of lower leg reconstruction.