The clinical applications of free have been extended tremendously in head and neck reconstruction. In a nine-year period, 92 microvascular free flaps were performed to repair the defects following major head and neck ablative surgery. Twenty-one transverse rectus abdominis myocutaneous flaps, 18 radial foream flaps, 15 latissimus dorsi muscle flaps, 12 jejunal flaps, 8 fibular osteocutaneous flaps, 6 rectus abdominis muscle flaps, 6 iliac osteomyocutaneous flaps, 2 groin fasciocutaneous flaps, 1 scapular fasciocutaneous flap, 1 parascapular osteocutaneous flap, 1 tensor fascia lata muscle flap and 1 serratus anterior muscle flap were used for reconstruction. Twenty-five maxillary defects including the orbit or skull base, 16 pharyngoesophageal defects, 15 intraoral defects, 15 mandibular defects, 13 scalp defects, 1 cervical region and 7 other facial region were covered with various free flaps. The overall success rate of the flaps was 95.6%. The complications included total flap loss (3 cases), partial flap loss (1 case), recurrence of primary tumors (15 cases), cerebrospinal fluid leakage (3 cases), fistula formation (3 cases) and infection (5 cases). Superficial temporal artery, facial artery, superior thyroidal artery, lingual artery, occipital artery, transverse cervical artery were commonly used recipient arteries and 7 cases of vein grafts were used if indicated. End to end anastomosis was performed in 84 cases and end to side anastomosis in 8 cases. The average follow-up period was 42 months, ranging from 6 months to 8 years. One patent died during postoperative intensive care due to sepsis and 19 patients died because of recurrence of tumors and underlying medical diseases during the follow-up period. Although free flaps may appear to be riskier than traditional forms of reconstruction, they offer the surgeon a greater spectrum of reconstructive options. Free flap reconstruction also improves the quality of life and minimizes the loss of function. Limitations of the use of free flaps result only from a lack of technical skills and specialized equipment.
Arteries ; Cerebrospinal Fluid ; Fascia Lata ; Fistula ; Follow-Up Studies ; Free Tissue Flaps* ; Groin ; Head* ; Humans ; Critical Care ; Myocutaneous Flap ; Neck* ; Orbit ; Quality of Life ; Rectus Abdominis ; Recurrence ; Scalp ; Sepsis ; Skull Base ; Superficial Back Muscles ; Temporal Arteries ; Thyroid Gland ; Transplants ; Veins

Until recently, cranial base tumors or midfacial tumors were deemed unresectable due to an inability to accurately diagnose the extent of the involvement and to approach and excise the tumor safely. With refinements in CT and NMR scanning, as well as the development of craniofacial technique, reconstruction has become absolutely crucial in allowing successful resection of these tumors. Resection of these tumors may sometimes result in massive and complex extirpation defects that are not amendable to local tissue closure. In such cases, free tissue transfer was an effective alternative because it can provide a large amount of well-vascularized tissues arts reliable separation of the intracranial space from bacterial flora of the upper airway. Microvascular free tissue transfer was used in 15 patients at our center to reconstruct the cranial base and/or midfacial defects. Of these 12 were free rectus muscle flaps, 2 were free latissimus dorsi muscle flaps, 1 was a free scapular osteocutaneous flap and 1 was a free scapular fasciocutanegus flap. There were 2 cases of total flap loss. In those cases, revisions were performed using latissimus dorsi muscle free flap in one case and STSG in the other. One patient had a postoperative cerebrospinal fluid leak which was spontaneously resolved by conservative management. The large complex defects were successfully reconstructed by one-stage operation and the functional and esthetic results wee satisfactory with acceptable complication rates.
Cerebrospinal Fluid ; Free Tissue Flaps ; Humans ; Skull Base* ; Superficial Back Muscles

The relaxed G-tolerances of 16 female cadets of ROKAF academy and 19 male privates were compared. The relaxed G-tolerance level was measured as visual endpoint (gray out or loss of peripheral light loss) during G-force raise steadily at 0.1 G/s. The G-stimulations were repeated twice with the interval of 30 s for 4 days (female cadets, 9 a.m.; male privates, 10 a.m.). The correlation between the relaxed G-tolerance level and their physical factor (height, sitting height, weight and lean body mass) and muscle strength (power of abdomen, back and thigh) was investigated. The average value of the relaxed G-tolerance levels of female cadets for 4 days was significantly higher than the one of male privates (4.23 +/-0.60, n=111; 4.04 +/-0.64, n=92; student 's t-test, P<0.05). However, the training effect of 4 days was not seen in either female cadet or male private group. The weight and lean body mass have significant positive correlation with the relaxed G-tolerance level. Also, the peak torque of thigh muscle have a strong positive correlation with it, but the endurance ratio does not.
Abdomen ; Female ; Humans ; Male ; Muscle Strength ; Thigh ; Torque

No abstract available.
Foot*

Microvascular surgery can provide the necessary soft tissue coverage from the remote donor areas by free flap transfer into the defect. Correct selection of the appropriate recipient vessels is difficult and remains the most important factor in successful free flap transfer. Recently, vascular anastomosis to recipient vessels distal to the zone of injury has been advocated and retrograde for flaps are well established in island flaps. Purpose of this study is to report our clinical experiences with lower extremity reconstruction in 9 patients. 9 patients with soft tissue defect below the knee underwent lower extremity reconstruction with distally based free flaps using retrograde arterial flow. For assessment of the retrograde flow, intraoperative retrograde arterial pressure was quantified and compared with systolic blood pressure taken at the same time. Suitable candidates had ben chosen with pulsatile retrograde flow and a diastolic retrograde arterial pressure of 60 mmHg. Three different free flaps were used. All flaps were successful. Retrograde flow anastomosis could not interrupting the major blood vessels which were essential for survival of the distal limb, the compromise of fracture or wound healing might be prevented. In cases wherein arteriography demostrates significant vascular flow interruption within the zone of injury, those are also candidate for retrograde arterial anastomosis.
Angiography ; Arterial Pressure ; Blood Pressure ; Blood Vessels ; Extremities ; Free Tissue Flaps* ; Humans ; Knee ; Lower Extremity ; Surgical Flaps ; Tissue Donors ; Wound Healing

Microsurgical free-tissue transfer has allowed surgeons to salvage injured limbs but choosing appropriate healthy recipient vessels has proved to be a difficult problem. Retrograde flow flaps are established in island flaps. Retrograde flow anastomosis could prevent the possible kinking and twisting of the arterial anastomosis. By not interrupting the proximal blood flow to the fracture or soft tissue defect site, the compromise of fracture or wound healing might be prevented. We wished to establish an animal model in rat for a retrograde arterial flow based free flap. Nembutal-anesthetized male rats, weighing 250 to 300 gm, were used. The femoral artery and common carotid artery exposed and divided. The systemic and retrograde arterial pressure were quantified by utilizing a paralle tubing system connected with peripheral arterial line. In this study, the retrograde flow was not pulsatile and the retrograde arterial pressure was 64-65 mmHg, with a mean arterial pressure of 106-109 mmHg. An epigastric skin flap, measuring 3x3 cm, was raised with its vascular pedicle. The epigastric free flap was transferred in the same rat from femoral vessels to carotid vessels in end to end fashion. We anastomosed the donor ateries to the distal parts of the divided recipient arteries and the donor veins to the proximal parts of the recipient veins. Twelve experiments were performed and the transplantations succeeded in 75 percent of them. In the remaining 25 percent, the experiments failed due to thrombosis at the site of anastomosis, or other causes. This animal model represents an excellent example of retrograde arterial flow free flap transfer that is reliable.
Animals ; Arterial Pressure ; Arteries ; Carotid Artery, Common ; Extremities ; Femoral Artery ; Free Tissue Flaps* ; Humans ; Male ; Models, Animal ; Rats ; Skin ; Surgical Flaps ; Thrombosis ; Tissue Donors ; Vascular Access Devices ; Veins ; Wound Healing

No abstract available.

No abstract available.
Emphysema* ; Tuberculosis*

The most common fracture about the elbow joint in chilren is a supracondylar fracture. The displaced fracture is difficult to manage due to the potential danger of Volkmann's ischemia, nerve injury, and malunion, During the period of 6 years from June, 1979 to June, 1985, 63 children with supracondylar fractures of the humerus were treated at Pusan Paik Hospital, Inje Medical College, and analyzed. The results are summarized as follows: 1. The average age was 7.1 years, ranged from 1 year to 14 years, and the male and female ratio was 2.5: l. 2. In type of fracture, extension type was 92% and flexion type was 8%. In displacement of fracture, Grade I was only 2 cases, Grade III and IV were 87.3%. Posteromedial displacement was 42.8% (27 cases). 3. At the time of admission, 15cases(23.8%) accompanied nerve injury, of these median nerve injury (9 cases) was most common. All the patient with nerve injury were completely recovered within 14 months after reduction. 4. Severe cubitus varus was 14.2%, and severe limitation of elbow motion was 1.6%. 5. Of 61 displaced fractures, 37 patients were treated with closed reduction and percutaneous pin fixation. By Flynn's criteria, satisfactory results were obtained in 36 of the 37 patients(97.3%) treated with percutaneous pinning. 6. In the displaced fractures, closed reduction and percutaneous pinning is a satisfactory method for obtaining and maintaining reduction while preserving vascular function, if acute flexion is necessary for stable reduction.
Busan ; Child ; Clinical Study ; Elbow ; Elbow Joint ; Female ; Fractures, Closed ; Humans ; Humerus ; Ischemia ; Male ; Median Nerve ; Methods

Thoracic disc herniation is an uncommon cause of thoracic cord compression. Herniation in this region is of particular importance because of the serious disorders of nervous function which result from anterior compresstion of the spinal cord. Early diagnosis and prompt surgical treatment are imperative because of the progressive and serious neurological deficit which results from delay. Numerous problems remain as to the safest surgical approach to the prolapsed thoracic intervertebral disc. We treated a case of herniated intervertebral disc occuring at Tll–T12 using the anterior approach. The result was favourable.
Early Diagnosis ; Intervertebral Disc ; Spinal Cord