• Archives of Plastic Surgery
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• v.50 no.1
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• pp.82-95
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• 2023

Upper extremity reconstruction may pose clinical challenges for surgeons due to the often-critical, complex functional demands of the damaged and/or missing structures. The advent of vascularized bone grafts (VBGs) has aided in reconstruction of upper extremity (UE) defects due to their superior regenerative properties compared with nonvascularized bone grafts, ability to reconstruct large bony defects, and multiple donor site options. VBGs may be pedicled or free transfers and have the potential for composite tissue transfers when bone and soft tissue are needed. This article provides a comprehensive up-to-date review of VBGs, the commonly reported donor sites, and their indications for the treatment of specific UE defects.

• Archives of Reconstructive Microsurgery
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• v.20 no.1
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• pp.82-88
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• 2011

Vascularized free fibula head transfer is an established method for reconstruction of long bone defects of the upper limb involving the distal radius or the proximal humerus. For the wrist following tumor resection, in cases of resection of the radial articular surface, three reconstructive options are possible: 1. fibular head transfer to replace the radial joint surface, 2. fixation of the fibula to the scaphoid and lunate, 3. complete wrist fusion. The decision on the type of the operation depends on the amount of the resection and the remained normal anatomical structures, and also the necessity of function of the wrist in the future. The authors believe that the vascularized free fibula head graft is a safe and reliable method for reconstructing the upper limb, especially for patients with a defect of the distal radius, and report the operative methods, donor vascular consideration, complications, and functional result after this operation.

• Archives of Reconstructive Microsurgery
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• v.9 no.2
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• pp.134-138
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• 2000

Arthrodesis of the ankle joint is inevitable in the cases of severe arthrosis or defective bony structures around ankle joint. There have been many kinds of arthrodesis methods were introduced. In cases with failed athrodesis with previous arthrodesis surgery and neuropathic joints have difficulty to achieve fusion of joint with conventional methods. Authors underwent four cases of ankle fusion with vascularized fibular graft from 1997 in the cases of three failed fusions and one diabetic neuropatic joint. Two of four performed free vascularized fibular transplantation from contralateral side leg with microvascular anastomosis, two of four performed with pedicled fibular transposition to the ankle joint in same side leg. Three of four cases achieved arthrodesis average 9.2 months after surgery, one case was failed due to vascular thrombosis of the anastomosed site in diabetic neuropathic condition. The result of this technique revealed 75%(three of four) success rate and longer bone union time required. However, in these cases had no recommendable options with conventional bone graft and additional ankle joint fusions procedure because of poor bone quality and defect of distal tibia and talus portions. Free vascualrized fibular transfer to the failed athrodesis of ankle joint is one of the effective alternative methods in failed ankle fusion cases, especially the quality of the bone around previous fusion site is poor.

• Archives of Reconstructive Microsurgery
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• v.9 no.1
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• pp.75-79
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• 2000

The foot plays a vital role in standing and gait. This function results from harmonious interaction of bones, joints, and soft tissue. An imbalance or a defect in such structures can lead to impaired function of the foot. The mid foot, composed of cunieforms, navicular and cuboid bone, plays a vital role in maintaining longitudinal and transverse arches and injury or defects to this region can cause instability of the foot. This paper reports a case of complex foot injury; soft tissue defect of dorsum of foot, and medial and intermediate cuneiform bone defect, reconstructed in a single stage using vascularized osteocutaneous fibular free flap. Segmented to fit the defects of medial and intermediate cuneiform bones and a skin paddle providing adequate coverage, restored the stability to the arches and function of the midfoot. The fibula osteocutaneous free flap has appealing characteristics for reconstruction of the foot and the complex mid foot injuries can be considered to the long list of indications.

• The Journal of the Korean dental association
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• v.49 no.9
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• pp.527-534
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• 2011

Microvascular reconstruction of maxillary composite defect after oncologic resection has improved both esthetic and functional aspect of quality of life of the cancer patients. However, a lot of patients had prior surgery with radiation and/or chemotherapy as a part of comprehensive cancer treatment. Sometimes it is nearly impossible to find out adequate recipient vessel for maxillary reconstruction with microvascular anastomosis. Therefore long pedicle of the flap is needed to use distant neck vessels located far from the reconstruction site such as ipsilateral transverse cervical artery or a branch of contralateral external carotid artery. For this reason, although we know the treatment of the choice is osteocutaneous flap, it is difficult to use this flap when we need long pedicle with complex three dimensional osseous defect. Vascular option for these vessel-depleted neck patients can be managed by a soft tissue reconstruction with long vascular pedicle and additional free non-vascularized flap that is rigidly fixed to remaining skeletal structures. For this reason, maxillofacial reconstruction by vascularized soft tissue flap with or without the secondary restoration of maxillary bone with non-vascularized iliac bone can be regarded as one of options for reconstruction of profound maxillofacial composite defect resulted from previous oncological resection with chemo-radiotherapy.

• International Journal of Stem Cells
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• v.15 no.1
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• pp.85-94
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• 2022

Background and Objectives: Brain organoids have the potential to improve our understanding of brain development and neurological disease. Despite the importance of brain organoids, the effect of vascularization on brain organoids is largely unknown. The objective of this study is to develop vascularized organoids by assembling vascular spheroids with cerebral organoids. Methods and Results: In this study, vascularized spheroids were generated from non-adherent microwell culture system of human umbilical vein endothelial cells, human dermal fibroblasts and human umbilical cord blood derived mesenchymal stem cells. These vascular spheroids were used for fusion with iPSCs induced cerebral organoids. Immunostaining studies of vascularized organoids demonstrated well organized vascular structures and reduced apoptosis. We showed that the vascularization in cerebral organoids up-regulated the Wnt/β-catenin signaling. Conclusions: We developed vascularized cerebral organoids through assembly of brain organoids with vascular spheroids. This method could not only provide a model to study human cortical development but also represent an opportunity to explore neurological disease.

• International Journal of Stem Cells
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• v.16 no.1
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• pp.1-15
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• 2023

Liver organoids have gained much attention in recent years for their potential applications to liver disease modeling and pharmacologic drug screening. Liver organoids produced in vitro reflect some aspects of the in vivo physiological and pathological conditions of the liver. However, the generation of liver organoids with perfusable luminal vasculature remains a major challenge, hindering precise and effective modeling of liver diseases. Furthermore, vascularization is required for large organoids or assembloids to closely mimic the complexity of tissue architecture without cell death in the core region. A few studies have successfully generated liver organoids with endothelial cell networks, but most of these vascular networks produced luminal structures after being transplanted into tissues of host animals. Therefore, formation of luminal vasculature is an unmet need to overcome the limitation of liver organoids as an in vitro model investigating different acute and chronic liver diseases. Here, we provide an overview of the unique features of hepatic vasculature under pathophysiological conditions and summarize the biochemical and biophysical cues that drive vasculogenesis and angiogenesis in vitro. We also highlight recent progress in generating vascularized liver organoids in vitro and discuss potential strategies that may enable the generation of perfusable luminal vasculature in liver organoids.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.35 no.5
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• pp.277-283
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• 2013

Purpose: Well vascularized pectoralis major myocutaneous flap (PMMF) had been a commonly used versatile flap in reconstructive oromaxillofacial surgery since the 1970s. However, after the advent of microvascular surgery in the 1980s, the PMMF was used less frequently. But, to date, PMMF has been useful and has some advantages such as covering wide defects, covering vital structures, back-up procedure in cases of free flap failure, and reconstruction for radiotherapy patients. The purpose of this study is to evaluate the role, indication, complications, functional, and aesthetic results of this flap in the era of free flap with a literature and chart review. Methods: A retrospective study was conducted of 16 oral cancer patients undergoing reconstructive surgery with PMMF for reconstruction of defects from 2001 to 2012 at Kyungpook National University Hospital. The male to female ratio was 10:6, with a mean age of 63 years (16~79 years). Basic demographic data, previous treatment history, indications, dimension of the flap, site of reconstruction, postoperative complications, and patients' final status were systemically analyzed from chart review. Results: The pathology of the disease included squamous cell carcinoma in the majority of cases (n=14). The remaining cases were fibrosarcoma and mucoepidermoid carcinoma. Of the 16 PMMF reconstructions, 13 flaps were applied as primary reconstructive procedures, whereas three flaps were; salvage; procedures (vascularized free flap failure). Twelve patients had complications such as wound dehiscence, infection, hematoma, fistula, flap bulkiness, and partial flap necrosis. The higher complication rates showed an association with utilization of the flap in preoperative radiotherapy cases. However, all patients were discharged without failure. Conclusion: In reconstructive oromaxillofacial surgery, the PMMF is still a useful flap for huge defects. In addition, the PMMF can be used as a salvage procedure after vascularized free flap failure and reconstruction for patients with a history of preoperative radiotherapy.

• Journal of Microbiology and Biotechnology
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• v.34 no.5
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• pp.1003-1016
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• 2024

This study explores the potential of plant-based decellularization in regenerative medicine, a pivotal development in tissue engineering focusing on scaffold development, modification, and vascularization. Plant decellularization involves removing cellular components from plant structures, offering an eco-friendly and cost-effective alternative to traditional scaffold materials. The use of plant-derived polymers is critical, presenting both benefits and challenges, notably in mechanical properties. Integration of plant vascular networks represents a significant bioengineering breakthrough, aligning with natural design principles. The paper provides an in-depth analysis of development protocols, scaffold fabrication considerations, and illustrative case studies showcasing plant-based decellularization applications. This technique is transformative, offering sustainable scaffold design solutions with readily available plant materials capable of forming perfusable structures. Ongoing research aims to refine protocols, assess long-term implications, and adapt the process for clinical use, indicating a path toward widespread adoption. Plant-based decellularization holds promise for regenerative medicine, bridging biological sciences with engineering through eco-friendly approaches. Future perspectives include protocol optimization, understanding long-term impacts, clinical scalability, addressing mechanical limitations, fostering collaboration, exploring new research areas, and enhancing education. Collectively, these efforts envision a regenerative future where nature and scientific innovation converge to create sustainable solutions, offering hope for generations to come.

• Archives of Reconstructive Microsurgery
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• v.10 no.1
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• pp.55-59
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• 2001

The hand is a frequently affected area in high voltage electrical burn injury as an input or output sites. Therefore, early debridement and synchronous flap coverage are generally accepted as a primary treatment of several electrical burns complicated by exposure of tendons, neurovascular structures, and bones. So, in order to establish convenient, promising methods for the reconstruction of hand defects in electrical burn patients, we performed various reverse forearm flaps. From March 1997 to February 2000, we reconstructed 12 cases of hand defects in high voltage electrical burn wounds with reverse forearm flaps. Reverse radial fasciocutaneous flap were 3 cases, reverse ulnar fasciocutaneous flap were 3 cases, reverse ulnar fasciocutaneous flap and STSG were 4 cases, reverse ulnar fascial flap and STSG were 2 cases. We successfully reconstructed hand defects in all 12 cases, and obtained following conclusions. 1 Various reverse forearm flaps provide well vascularized, profitable tissues and they require short operative time with relatively easy procedures. 2. Reverse fascial flap and STSG, reverse fasciocutaneous flap and STSG provide thin flaps with good aesthetics and minor donor site morbidity.