PURPOSE: The coverage of distal soft tissue defects and bony exposure of the lower extremity has long been recognized to be difficult clinical problem. Covering with a local skin flap is usually impractical because of the extensive and deep crush, hence free flap has been used commonly for the coverage of the wound. Although it can provide good results, it has many disadvantages. Designing an adipofascial flap raised on perforating vessels of the posterior tibia artery is a reliable and simple method to perform, and it can solve these problems. METHODS: From May 2005 to May 2006, 8 patients underwent reconstruction of lower leg defects utilizing various type of the posterior tibial artery perforator adipofascial flaps. The flap provided a durable and thin coverage for the defect, as well as a well vascularized bed for skin grafting. RESULTS: The flap size ranged 15-80cm(2), and skin graft was done for the recipient site. The flap were successfully used for the lower extremity reconstruction in most cases. Minor complications occurred in 4 cases. There was no functional disability of the donor site with esthetically pleasing results. Furthermore, these flaps were both easy to raise and insured sufficient arterial blood supply. CONCLUSION: We believe there are many advantages to this posterior tibial artery perforator adipofascial flap and that it can be highly competitive to the free flaps in the lower extremity reconstruction.
Arteries ; Free Tissue Flaps ; Humans ; Leg* ; Lower Extremity ; Perforator Flap ; Skin ; Skin Transplantation ; Tibia ; Tibial Arteries ; Tissue Donors ; Transplants ; Wounds and Injuries

PURPOSE: The gluteal artery perforator flaps earned its popularity in buttock reconstruction due to the lower morbidity of the donor site and the flexibility in the design. Speedy and safe reconstruction is important for the success of buttock reconstruction. If a proper design is selected, satisfactory results can be obtained with more simple method of surgery. METHODS: Between April 2005 and April 2006, buttock reconstruction by using gluteal artery perforator flaps were performed on sacral sores(6 cases), ischial sores(2 cases) and malignant melanoma on buttock(1 case). Various designs depending on the location and the size of the defect was made. In those designs, perforator was used as an axis for the minimal dissection of the vessel. Donor site from which sufficient amount of soft tissue can be transferred was selected, and also not causing high tension against the recipient site during the donor site closure. In addition, postoperative aesthetics, and the possibility of another design of a second operation which can be necessary in the future, was considered. RESULTS: Patient follow up was for a mean period of 10.8 months. All flaps survived except for one that had undergone partial necrosis. Wound dehiscence was observed in one patient treated by secondary closure. Most patients presented with cosmetically and functionally satisfying results CONCLUSION: By designing the flap using the perforator as an axis, depending on the defect size and degree, reconstruction can be performed with only a small tension to the donor and the recipient site. And the minimal perforator dissection allowed easier and faster reconstruction. Selection of a proper design is the key procedure which greatly affects operation time and result success.
Arteries* ; Axis, Cervical Vertebra ; Buttocks* ; Esthetics ; Follow-Up Studies ; Humans ; Melanoma ; Necrosis ; Perforator Flap* ; Pliability ; Tissue Donors ; Wounds and Injuries

No abstract available.
Osteochondroma*

No abstract available.
Humans ; Lymphedema*

In neurosurgical cases, problems related to wound healing can vary from simple wound dehiscence to multilayer defects. This study demonstrates an effective method to prevent persistent cerebrospinal fluid (CSF) leakage using reinforcing acellular dermal matrix in neurosurgical patients with wound dehiscence. A 52-year-old woman was admitted for management of recurrent glioblastoma. After tumor removal surgery, the patient experienced sustained CSF leakage from the wound despite reparative attempts. The plastic surgery team performed wound repair procedure after remnant tumor removal by the neurosurgery team. Acellular dermal matrix was applied over the mesh plate to prevent CSF leakage and the postoperative status of the patient was evaluated. No sign of CSF leakage was found in the immediate postoperative period. After 3 years, there were no complications including CSF leakage, wound dehiscence, and infection. We hereby propose this method as a feasible therapeutic alternative for preventing CSF leakage in patients experiencing wound problem after neurosurgical procedures.

Conventional direct surgical excision has been the most reliable method in the treatment of the benign tumor in the face but it inevitably leaves visible scar. Although studies of endoscopy-assisted excision in forehead and lateral brow masses representing a diverse group of lesions including lipoma, dermoid cyst and osteoma have been reported, the number of patients was limited. We treated 33 cases of various benign forehead masses with endoscopy-aided surgery from April, 1999 to July, 2004, and the age of the patients ranged from 5 to 54 years. Two slit incisions less than 1.5cm were placed behind the anterior hairline and tumor was excised after the subperiosteal pocket dissection. All masses were completely excised and pathologists confirmed that 19 cases were lipomas, 8 were dermoid cysts and 6 were osteomas. The size of the masses varied from 0.9x0.8cm to 5.0x4.0 cm. Complications such as tumor recurrence, scalp numbness and frontalis paralysis did not occur. There was no contour irregularity found in our series. Incision scars were hidden well posterior to the hairline, so patients were satisfied with the final results. After many experiences, we concluded that endoscopic excision is a simple and undoubtedly safe method, and provides excellent cosmesis in treating not only lipoma but also dermoid cyst and osteoma. It is an effective method for complete excision of various types of tumors in the forehead and brow.
Cicatrix ; Dermoid Cyst ; Endoscopy ; Forehead* ; Humans ; Hypesthesia ; Lipoma ; Osteoma ; Paralysis ; Recurrence ; Scalp

PURPOSE: Dermoid cysts are almost always caused by congenital events. The most widely accepted pathogenesis is that the cysts are dysembryogenetic lesions that arise from ectodermic elements entrapped during the midline fusion. We report a rare case of dermoid cyst, which occurred not congenitally but newly in the subcutaneous scar tissue secondary to trauma. METHODS: A 26-year-old man had a deep submental laceration caused by a car accident and got a primary wound closure 16 months ago. There were 18 cm-long submental hypertrophic scar and newly developed palpable masses inside the subcutaneous layer at the center of the scar. Initial impression was an epidermal cyst or a thyroglossal duct cyst. Ultrasonographic finding showed two cystic masses inside the scars at the submental area, but impressed dermoid cysts. The cystic masses were completely removed with W-plasty and histological examination were followed. RESULTS: The histological diagnosis was dermoid cysts which were mainly composed of keratotic squamous epithelium in their inner surface linings and numerous skin appendages such as sebaceous glands, sweat glands, and hair follicles in their cystic lumens histopathologically. During the follow-up period of 25 months, there was no recurrence of any subcutaneous mass in the site of scar. CONCLUSION: We report a very unusual case of dermoid cysts developed by an acquired cause, considering that the accidental inclusion of deep skin elements caused by a trauma can be a critical origin of dermoid cysts.
Adult ; Cicatrix* ; Cicatrix, Hypertrophic ; Dermoid Cyst* ; Diagnosis ; Ectoderm ; Epidermal Cyst ; Epithelium ; Follow-Up Studies ; Hair Follicle ; Humans ; Lacerations ; Recurrence ; Sebaceous Glands ; Skin ; Sweat Glands ; Thyroglossal Cyst ; Wounds and Injuries

PURPOSE: The basic vascular anatomy and versatility of the anterolateral thigh flap was reported firstly by Song in 1984 and then by Zhang who introduced the reverse flow pattern of this flap. In this case, the authors reviewed various articles and their experiences with the distally based anterolateral thigh flap and applied it for coverage of bone-exposed wound occurred at the distal of the disarticulated knee stump. We consequently reported the reliability and resourcefulness of this flap in the difficult and limited situation. METHODS: A 67-year-old-man who had suffered from arteriosclerotic obliterans inevitably underwent the disarticulation at knee joint due to clinical deterioration. He presented to our clinic with soft tissue necrosis and bone exposure at the stump. We debrided the wound and conducted the distally based anterolateral thigh island flap by transecting proximal portion of descending branch of the lateral circumflex femoral artery and the 14x10cm sized flap was transferred to cover the defect. The pedicle measured 14cm in length with pivot point 7cm above the patella. RESULTS: The postoperative course was mainly uneventful except early venous congestion for 4 days and subsequent partial skin loss. The wound was healed by secondary intension and no other sequelae had been observed during follow-up period of 12 months. CONCLUSION: Despite the presence of various reconstructive choices, the distally based anterolateral thigh island flap can be designed to repair soft tissue defects around the knee region, providing its reliable blood supply and long pedicle length, especially in the challenging cases.
Disarticulation ; Femoral Artery ; Follow-Up Studies ; Hyperemia ; Knee Joint ; Knee* ; Music ; Necrosis ; Patella ; Skin ; Thigh* ; Wounds and Injuries

The purpose of this study is to evaluate the effect of the presurgical infant orthopedics and the nasoalveolar molding in unilateral complete cleft lip and palate by the analytic system using standardized photographs. This study involved 34 patients with unilateral complete cleft lip and palate(24 male, 10 female, mean age 4.9 years) who underwent a rotation-advancement flap repair between 1995 and 1998 by single surgeon. Follow-up photographs were taken at a time average 3.8 years(2-7ears) after surgery. The patients were divided into three groups Group I(9 patients) consists of those who underwent cheiloplasty and primary rhinoplasty without presurgical infant orthopedics. Group II(10 patients) consists of those who underwent cheiloplasty and primary rhinoplasty with presurgical alveolar molding alone without nasal molding, and Group III(15 patients) consists of those who underwent presurgical alveolar molding with nasal molding without primary rhinoplasty. Facial proportions and angles were measured on standardized photographs using defined anthropometric points. All linear parameters were converted to the percentage values. In addition, the qualitative measurements were performed on scar quality, nostril symmetry and alar symmetry. Comparisons between group I and II and those between group II and III were made in all parameters. Results were analyzed by Mann-Whitney/ Wilcoxon rank sum test. Between group I and II, there was a significant increase in upper lip height symmetry in group II(p= 0.014). Between group II and III, upper lip height symmetry and Cupid's bow length symmetry significantly increased in group II(p=0.002, p=0.012). The other quantitative and qualitative parameters didn't make the difference between groups. In conclusion, the infant orthopedics increases upper lip height of cleft side and has the effect to obtain the upper lip symmetry. But the nasoalveolar molding has no effect to increase the nasal symmetry. So the nasoalveolar molding alone appears to be insufficient to replace the infant orthopedics with primary rhinoplasty.
Cicatrix ; Cleft Lip* ; Female ; Follow-Up Studies ; Fungi ; Humans ; Infant* ; Lip* ; Male ; Nose* ; Orthopedics* ; Palate* ; Rhinoplasty

Although antithrombotic drug therapy is not a substitute for precise surgical technique, it has become an important adjunct for the microsurgeon performing replantation and elective free-tissue transfers. Systemic anticoagulant use in 60 free flap procedures performed from January 2001 to February 2004 was reviewed to determine the flap loss rate, associated risk of hematoma formation and heparin-induced thrombocytopenia. Patients were divided into two groups: a single intraoperative bolus of 1250 units of heparin(20 flaps, Group 1), 2500 units(40 flaps, Group 2) respectively. Partial and complete flap loss rate was higher in Group 1(35 percent) than in Group 2(10 percent). Neither the difference in hematoma incidence nor the difference in thrombocytopenia incidence between two groups was significant and there was no case presenting heparin- induced thrombocytopenia. We have encountered unusually high flap loss rate in the group who received a single intraoperative bolus of 1250 units of heparin. Although a cause-and-effect relationship between the use of systemic heparin and flap loss or prevention of thrombosis could not be established, it seems to be beneficial that a single bolus of 2500 units of heparin is given intraoperatively without significantly increasing the risk of hematoma or heparin-induced thrombocytopenia.
Drug Therapy ; Free Tissue Flaps* ; Hematoma ; Heparin* ; Humans ; Incidence ; Replantation ; Thrombocytopenia ; Thrombosis