As the use of free tissue reconstruction becomes more routine, attention is being focused not only on flap survival, but also on functional refinements in these flaps. One of the more important aspects of improving the outcome of these reconstruction may relate to the return of sensation. The anterolateral thigh free flap is based on the descending branch of the lateral circumflex femoral artery. This fasciocutaneous flap is indicated whenever a relatively thin flap is required in reconstruction. A neurosensory flap can be employed based on the anterior branched of the lateral femoral cutaneous nerve of the thigh. Since 1996, 15 patients with soft tissue defect on various regious were treated by using the anterolateral thigh sensate free falp. All flaps survived without total loss. Anastomosis of the sensible nerve on the recipient site with the anterior branch of the lateral femoral cutaneous nerve of the thigh was performed. All patients showed recovery of sensation in the anterolateral thigh sensate free falp beginning between the 4th and 6th month postoperatively. Follow-up periods ranged from 8 to 34 months and the results of sensory recovery were satisfactory. Therefore, resensitization of an anterolateral thigh free flap should be attempted by a nerve anastomosis in this transplant. The longterm success in this study suggests the benefits of microsurgical neurotization in free tissue transplantation.
Femoral Artery ; Follow-Up Studies ; Free Tissue Flaps* ; Humans ; Nerve Transfer ; Sensation ; Thigh* ; Tissue Transplantation ; Transplants

No abstract available.
Lymphangioma*

Basal cell carcinoma(BCC) and squamous cell carcinoma (SCC) are very prevalent neoplasms of the human skin. Ultraviolet radiation in sunlight is a well-established mutagen of the p53 gene and is one of basal cell carcinoma and squamous cell carcinoma. The newly-formed vascular network is important for neoplasms to grow beyond a size of about 1 mm2. Recent reports have suggested the hypothesis that a mutant p53 protein is closely related with capillary density. Immumohistochemistry for p53 protein and CD34 was performed in 20 cases of BCCs and 14 SCCs to evaluated the relationship between p53 protein and capillary density. The results were as follows:1. The microvessels stained by CD34 were mainly located in the interface of tumor cells and stroma. 2. There was no difference in the microvessel density according to the histologic types and age of the patients, but a higher microvessel density was noted in male patients. 3. The aggressive BCCs and the less-differentiated SCCs showed higher p53 immunostaining. 4. The mean microvessel density of cases showing strong positive immunostaining of the p53 gene(54.73+/-17.75) was higher than that of others(39.75+/-18.30). These results suggested that p53 protein expression and microvessel density are not related to the histologic types and age of the patients, but that differentiation and biologic behavior such as the infiltrating property of tumors and the microvessel density are closely related to p53 protein expression.
Capillaries ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell* ; Genes, p53 ; Humans ; Male ; Microvessels* ; Skin* ; Sunlight

BACKGROUND: Glomus tumors were first described by Wood in 1812 as painful subcutaneous tubercles. It is an uncommon benign neoplasm involving the glomus body, an apparatus that involves in thermoregulation of cutaneous microvasculature. Glomus tumor constitutes 1%-5% of all hand tumors. It usually occurs at the subungual region and more commonly in aged women. Its classical clinical triad consists of pain, tenderness and temperature intolerance, especially cold sensitivity. This study reviews 15 cases of glomus tumor which were analyzed according to its anatomic location, surgical approach and histologic findings. METHODS: Fifteen patients with subungual glomus tumors of the hand operated on between January 2006 and March 2013, were retrospectively reviewed. Patients were evaluated preoperatively with standard physical examination including ice cube test and Love's test. Diagnostic imaging consisted of ultrasonography, computed tomography, and magnetic resonance imaging. All procedures were performed with tourniquet control under local anesthesia. Eleven patients underwent excision using the transungual approach, 3 patients using the volar approach and 1 patient using the lateral subperiosteal approach. RESULTS: Total of 15 cases were reviewed. 11 tumors were located in the nail bed, 3 in the volar pulp and 1 in the radial aspect of the finger tip. After complete excision, patients remained asymptomatic in the immediate postoperative period. In the long term follow up, patients exhibited excellent cosmetic results with no recurrence. CONCLUSIONS: Accurate diagnosis should be made by physical, radiologic and pathologic examinations. Preoperative localization and complete extirpation is essential in preventing recurrence and subsequent nail deformity.
Anesthesia, Local ; Body Temperature Regulation ; Congenital Abnormalities ; Diagnosis ; Diagnostic Imaging ; Female ; Fingers ; Follow-Up Studies ; Glomus Tumor* ; Hand* ; Humans ; Ice ; Magnetic Resonance Imaging ; Microvessels ; Physical Examination ; Postoperative Period ; Recurrence ; Retrospective Studies ; Tourniquets ; Ultrasonography ; Wood

The most common anatomic variant seen in donor kidneys for renal transplantation is the presence of multiple renal arteries, which can cause an increased risk of complications. Accessory renal arteries should be anastomosed to the proper source arteries to improve renal perfusion via the appropriate vascular reconstruction techniques. In microsurgery, 2 kinds of vascular augmentation methods, known as ‘supercharging’ and ‘turbocharging,’ have been introduced to ensure vascular perfusion in the transferred flap. Supercharging uses a distant source of the vessels, while turbocharging uses vascular sources within the same flap territory. These technical concepts can also be applied in renal transplantation, and in this report, we describe 2 patients who underwent procedures using supercharging and turbocharging. In one case, the ipsilateral deep inferior epigastric artery was transposed to the accessory renal artery (supercharging), and in the other case, the accessory renal artery was anastomosed to the corresponding main renal artery with a vascular graft (turbocharging). The transplanted kidneys showed good perfusion and proper function. No cases of renal failure, hypertension, rejection, or urologic complications were observed. These microsurgical techniques can be safely utilized for renal transplantation with donor kidneys that have multiple arteries with a lower complication rate and better outcome.
Arteries ; Epigastric Arteries ; Humans ; Hypertension ; Kidney ; Kidney Transplantation* ; Microsurgery ; Perfusion ; Reconstructive Surgical Procedures ; Regional Blood Flow ; Renal Artery ; Renal Insufficiency ; Tissue and Organ Harvesting ; Tissue Donors ; Transplants

With the advent of microsurgery, perforator free flap is nowadays considered the first choice for reconstruction of the extensive defect of the extremities because of their moderate thickness. Among them, anterior (anterolateral and anteromedial) thigh perforator free flaps provide the first choice for reconstruction of various soft tissue defects of the extremities with many advantage such as its large, uniform thickness, long vascular pedicle with proper vessel size and minimal donor site morbidity. But, it has still some criticism of unreliable perforators which makes us very careful in elevating the flap. Between March of 2006 and February of 2007, we treated 7 patients of soft tissue defects in the hand and lower extremities with anterior thigh perforator free flap at Hallym and DongGuk University Hospital. We performed 6 anterolateral thigh perforator free flaps based on the descending branch of lateral circumflex femoral artery (LCFA) and 1 anteromedial thigh perforator free flap based on the innominate branch of the LCFA. While approaching for the anterolateral thigh free flap, we happen to meet the cases which we should change into the anteromedial thigh free flap uneventfully on the operating field. In contrast to the original design of anterolateral thigh free flap, we had to harvest the anteromedial thigh perforator free flap in 1 case. All the anterior thigh perforator free flaps survived completely except 1 case of partial necrosis due to venous congestion. Donor sites were closed primarily and healed uneventfully within 2 weeks. Patients were satisfied with the functionally and aesthetically acceptable results. Although doppler sonography is strongly recommended preoperatively in planning the anterior thigh perforator free flaps, we should always remember the variation in vascular anatomy and be ready to change the flap choice from the anterolateral to anteromedial intraoperatively. we provide a review of the literature and present our series of anterior thigh perforator free flaps for reconstruction of the extremities.
Extremities* ; Femoral Artery ; Free Tissue Flaps* ; Hand ; Humans ; Hyperemia ; Lower Extremity ; Microsurgery ; Necrosis ; Thigh* ; Tissue Donors

PURPOSE: The survival of composite graft is dependent on three steps, (1) plasmatic imbibitions, (2) inosculation, and (3) neovascularization. Among the many trials to increase the survival rate of composite graft, prostaglandin E1 (PGE1) has beneficial effects on the microcirculatory level with vasodilating, antithrombotic, anti-inflammatory and neoangiogenic properties. Lipo-PGE1 which is lipid microspheres containing PGE1 had developed to compensate the systemic and local side effects of PGE1. This study was proposed to determine whether Lipo-PGE1 administration enhanced the survival of composite graft through neovascularization quantitatively in a rabbit ear model. METHODS: Fourteen New Zealand White Rabbits each weighing 3~4 kg were divided in two groups: (1) intravenous Lipo-PGE1 injection group and (2) control group. A 2 x 1 cm sized, full-thickness rectangular composite graft was harvested in each auricle. Then, the graft was reaaproximated in situ using a 5-0 nylon suture. For the experimental group, 3 microgram/kg/day of Lipo-PGE1 (5 microgram/mL) was administered intravenously through the marginal vein of the ear for 14 days. The control group was received no pharmacologic treatment. On the 14th postoperative day, composite graft of the ear was harvested and immunochemistry staining used Monoclonal mouse anti-CD 31 antibody was performed. Neoangiogenesis was quantified by counting the vessels that showed luminal structures surrounded by the brown color-stained epithelium and counted from 10 random high-power fields (400x) by independent blinded observer. Statistical analysis (Wilcoxon Signed Ranks test for nonparametric data) was performed using SPSS v12.0, with values of p<0.05 considered significant. RESULTS: The mean number of the microvessels was 15.48 +/- 8.65 in the experimental group and 9.82 +/- 7.25 in the control group (p=0.028). CONCLUSION: The use of Lipo-PGE1 facilitated the neoangiogenesis, resulted in the improvement of the survival rate of graft. On the basis of this results, we could support wider application of Lipo-PGE1 for more effective therapeutic angiogenesis and successful survival in various cases of composite graft in the human.
Alprostadil ; Animals ; Ear ; Epithelium ; Humans ; Immunochemistry ; Mice ; Microspheres ; Microvessels ; Nylons ; Phenobarbital ; Rabbits ; Survival Rate ; Sutures ; Transplants ; Veins

Ganglion cyst is the most common benign tumor arising from the hand and wrist. Rarely, they are found within the tendon. To date, only 10 cases in English papers and 7 cases in domestic papers on ganglion cysts in extensor digitorum tendons have been reported. Due to the rarity of this entity, it is difficult to suspect intratendinous ganglion fully based on the physical examination. Accordingly, preoperative studies such as ultrasonography, magnetic resonance imaging are recommended when suspicious result is revealed on the physical examination. Treatment should include en bloc resection of the affected tendon to reduce recurrence. But functional loss always has to be considered. This study reports two cases of intratendinous ganglion cysts that arised from the second and fourth extensor digitorum tendon.
Ganglion Cysts* ; Hand ; Magnetic Resonance Imaging ; Physical Examination ; Recurrence ; Tendons* ; Ultrasonography ; Wrist

For the venous flap to survive, it apparently needs to be a flow-through of venous blood.1 Nevertheless, controversy remains, regarding the fact that an island flap based on a terminating venous pedicle is capable of maintaining viability.2-15 This study was designed to investigate the role of perivenous areolar tissue in the viability of island flaps with an exclusively venous pedicle in the rabbit ear model as described by Inada et al.16 Ten groups of flaps were studied: Group A-flaps based on a proximal venous pedicle; group B-flaps based on a distal venous pedicle; group C- nonvascularized grafts; each subgroup A1-, B1-flaps with perivenous areolar tissue; each subgroup A2-, B2-flap which was skeletonized pedicle; each subgroup A3-, B3-flap was same as A1-, B1-flap, which was sutured over a silastic sheet; each subgroup A4-, B4-flap with a skeletonized venous pedicle sutured over a silastic sheet; subgroup C1-control, placed directly on bed; subgroup C2-control which was sutured over a silastic sheet. Groups A3, A4, B3 and B4 had 20 flaps and the remaining groups had 10 flaps each. Flaps in group A1, A3, B3 had total survival. In groups A4, B4, C2, no flaps were survived. The survived flaps in groups A3 and B3 had tissue oxygen content values between those of arterial and venous levels. Histological examination of the pedicle of survived flaps in groups A3 and B3 showed small vascular channels present in the areolar tissue surrounding the venous pedicle. Static and dynamic computerized radioactive tracer experiments showed that the survived flaps in groups A3 and B3 were promptly perfused and drained through their pedicles. This study confirms the importance of the perivenous areolar tissue for survival of the venous skin flap in the rabbit ear model.
Ear ; Oxygen ; Skeleton ; Skin ; Surgical Flaps* ; Transplants

PURPOSE: The key of treatment in syndactyly is to separate the fused digits safely, and to create a normal web space with enough cutaneous coverage. Despite many techniques have described the correction of syndactyly, skin graft still remains the annoying one. We designed the pentagonal flap from hand dorsum to reconstruct the web space reliably and try to minimize the need for skin graft. METHODS: Between July 2003 and August 2005, six cases of syndactyly were corrected at UCLA Medical Center and Hallym University Sacred Heart Hospital using dorsal pentagonal flap for web space reconstruction and straight incisions for the sides of digits to minimize the need for skin graft. The proximal edge of the pentagonal flap was designed in V shape to allow for easy closure of the donor site after advancement. The pentagonal flap was advanced volarly with the underlying dermofat tissues to form a digital web. In some cases, skin defects were unavoidable and covered with full thickness skin graft from the inguinal area. RESULTS: Syndactyly were seen in 4 cases of Apert syndrome, 1 postburn scar webbing with PIP joint contracture and 1 recurrence after the incomplete reconstruction. In all Apert syndrome, straight line incision was used along the sides of the fingers and skin graft was needed. But, in 2 cases of incomplete type, we could save the need for skin graft only for the correction of syndactyly. We could get a good looking web space without any complications such as flap or graft loss. CONCLUSION: As a modification of Sherif's V-Y dorsal metacarpal flap, we believe pentagonal flap could be one of the easiest and safest way to reconstruct the web space of syndactyly in functional and cosmetic standpoint.
Acrocephalosyndactylia ; Cicatrix ; Contracture ; Fingers ; Hand ; Heart ; Humans ; Joints ; Recurrence ; Skin* ; Syndactyly* ; Tissue Donors ; Transplants*