BACKGROUND: The aim of this study was to determine the efficacy of lateral intercostal artery perforator-based adipofascial free flaps for facial reconstruction in patients with facial soft tissue deficiency. METHODS: We conducted a retrospective study of five consecutive patients diagnosed with facial soft tissue deficiency who underwent operations between July 2006 and November 2011. Flap design included the area containing the perforators. A linear incision was made along the rib, which had the main intercostal pedicle. First, we dissected below Scarpa's fascia as the dorsal limit of the flap. Then, the adipofascial flap was elevated from the medial to the lateral side, including the perforator that pierces the serratus anterior muscle after emerging from the lateral intercostal artery. After confirming the location of the perforator, pedicle dissection was performed dorsally. RESULTS: Dominant perforators were located on the sixth to eighth intercostal space, and more than four perforators were found in fresh-cadaver angiography. In the clinical case series, the seventh or eighth intercostal artery perforators were used for the free flaps. The mean diameter of the pedicle artery was 1.36 mm, and the mean pedicle length was 61.4 mm. There was one case of partial fat necrosis. No severe complications occurred. CONCLUSIONS: This is the first study of facial contour reconstruction using lateral intercostal artery perforator-based adipofascial free flaps. The use of this type of flap was effective and can be considered a good alternative for restoring facial symmetry in patients with severe facial soft tissue deficiency.
Angiography ; Arteries* ; Fascia ; Fat Necrosis ; Free Tissue Flaps* ; Humans ; Muscles ; Perforator Flap ; Retrospective Studies ; Ribs

Korean ginseng (Panax ginseng C. A. Meyer) is one of the most popular medicinal herbs in the world. This plant is known to have many health benefits and contain a wide variety of bioactive components. However, the knowledge on its lipid compound is still far from being fully explored. Although glycosyl inositol phosphoceramides (GIPCs) are the main sphingolipids in plant tissues, GIPCs of P. ginseng are unknown. The present study employed nanoESI-MS n , which generated characteristic fragmentation pattern that were used for the structural identification of P. ginseng GIPCs. In addition to detecting a typical mass fragmentation pattern for GIPC in positive ion mode, novel fragmentation correlating with cleavage of the last carbohydrate and fatty acyl chain of the ceramide moiety was identified. In total, 42 GIPC species were detected in P. ginseng. The major P. ginseng GIPC structure was hexose (R 1 )-hexuronic acid-inositol phosphoceramide, with three types of R 1 (amine, N-acetylamine, or hydroxyl). The most intense peak was found at m/z 1136.3 ([M+H] + ion), corresponding to a GIPC (d18:0/h16:0, R 1 = OH). Only three GIPC subtypes showed significantly different levels in five- and six-year-old P. ginseng tap roots.