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Surgical treatment of livedo vasculitis.

Kyung Dong SON ; Do Myung CHANG ; Paik Kwon LEE ; Young Jin KIM ; Chong Kun LEE ; Poong LIM

Journal of the Korean Society of Plastic and Reconstructive Surgeons.1998;25(4):697-701.

Livedo vasculitis is thought to be a thrombogenic disorder that is related to the autoimmune disease. It clinically shows purplish mottling and recurrent painful ulcers in the lower extremities, leaving atrophie blanche after healing of the ulcers. Histopathologic finding are thrombotic occlusion in the mid-dermal vessels without necrotizing vasculitis. The therapeutic approach has largely been made by the use of drugs that stimulate endogenous fibrinolytic activitiy, that inhibit thrombus formation, or that cause vasodilation, but surgical intervention by excision and skin graftion has rarely been reported as a primary treatment.In our experience, two patients with livedo vasculitis, who had been unresponsive to various medications, were treated with wide excision and several times of skin grafting. And they experienced complete healing without recurrence.
Autoimmune Diseases ; Humans ; Lower Extremity ; Recurrence ; Skin ; Skin Transplantation ; Thrombosis ; Ulcer ; Vasculitis* ; Vasodilation

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Reconstruction of the soft tissue deffect of lower extremity in complicated case.

Jeong Soo LEE ; Taek Keun KWON ; Dong Jin LEE ; Jin Han CHA ; Yang Woo KIM

Journal of the Korean Society of Plastic and Reconstructive Surgeons.1998;25(4):686-696.

This study includes 19 cases of complicated low extremity injury to whom underwent microvascular free-tissue transfer in cases of open comminuted fracture, osteomyelitis, and vascular compromise or extensive soft tissue defect from Nov. 1994 to July 1997. The average time after injury to coverage was 25 days. The nineteen patients underwent a total of nineteen free tissue transfers primarily, and eighteen (94.7 per cent) of the transfers survived. Major complications were encountered recurrent failure of the free tissue transfer in one patient and partial necrosis in the other flap, which were successfully treated by flow-through radial forearm free flap and distally based superficial sural artery flap respectively. Two patients were sustained below knee amputation, one above knee amputation, despite of survival of flaps. This reveals limb salvage in 84 percent. The microvascular reconstruction is a versatile and reliable methods in complicated cases after severe trauma. Free tissue transplantation should be considered as a primary treatment in such complicated cases.
Amputation ; Arteries ; Extremities ; Forearm ; Fractures, Comminuted ; Free Tissue Flaps ; Humans ; Knee ; Limb Salvage ; Lower Extremity* ; Necrosis ; Osteomyelitis ; Tissue Transplantation ; Transplants

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Bone infection associated with pressure sores: a clinical study.

Hang Seok CHOI ; Gyeol YOO ; Jong Won RHIE ; Sung Shin WEE ; Poong LIM

Journal of the Korean Society of Plastic and Reconstructive Surgeons.1998;25(4):679-685.

Pressure sores are common complications in patients with spinal injuries or cerebrovascular accidents. The management of pressure sores requires prolonged hospitalization and repeated surgical interventions with a high recurrence rate. Particularly osteomyelitis following initial pressure sores persistently complicates wound healing and recovery. Furthermore, it may also ultimately result in serious sepsis; thus an early diagnosis of osteomyelitis in pressure sore patients is crucial along with appropriate surgical and antibiotic therapy. Although many diagnostic methods were reported, there is no single 'gold' standard for early diagnosis of pressure sore-associated osteomyelitis. Authors reviewed pre-operative CBC, plain X-ray, Tc-99m bone scan, and post-operative biopsy results in 37 patients who had received surgical treatment for pressure sores in a 5-year period from September 1991 to August 1996. Based on these reviews, authors compared and analyzed the sensitivity and specificity in diagnosing osteomyelitis.The results were as follows: 1. Of 37 patients studied, 25 cases were confirmed histologically as osteomyelitis. Ischial region revealed the highest incidence of pressure sore-related osteomyelitis(78%, 14 out of 18 cases) while the regional incidence was as following in descending order : ischial, sacral, and greater trochanteric area. 2. Tc-99m bone scan had superior sensitivity(100%) and specificity(83%) to other pre-operative studies in diagnosing osteomyelitis.In conclusion, authors suggest that Tc-99m bone scan is the best diagnostic method because of its high sensitivity and specificity if osteomyelitis is clinically suspected in pressure sore patients. And in case the test result is positive, agressive surgical bone resection and appropriate antibiotic therapy based on bacterial culture from deep bone specimen should be combined to prevent complications or recurrences.
Biopsy ; Early Diagnosis ; Femur ; Hospitalization ; Humans ; Incidence ; Osteomyelitis ; Pressure Ulcer* ; Recurrence ; Sensitivity and Specificity ; Sepsis ; Spinal Injuries ; Stroke ; Wound Healing

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Sacral pressure sore treatment with gluteal perforator-based flap.

Gyu Suk HWANG ; Won Min YOO ; Eul Je CHO ; Kwan Chul TARK ; Beyoung Yun PARK

Journal of the Korean Society of Plastic and Reconstructive Surgeons.1998;25(4):673-678.

Sacral pressure sores have been treated by a variety of surgical methods. complete treatment needs wide excision and coverage with healthy tissue which has constant and sufficient blood supply. Use of gluteus maximus muscle flap with or without overlying skin is a revolutionary method because of the reliability of blood supply. However, it is technically a little bit complicated, and future reconstruction for recurrent decubitus is especially limited in paraplegic patients. The development of gluteal perforator-based flap with para-sacral perforator introduce a new treatment modality for the sacral pressure sores. Total 10 cases of sacral pressure sores were treated with gluteal perforator-based flap. There were minimal postoperative complications except wound dehiscence in one case. This flap has a many advantage of no transection or sacrifice of the gluteus maximus muscle, elevation time for the flap is short, reliable blood flow of the perforator, large rotation arc and no post-operative hindrance to walking in patients who are not paraplegic. The disadvantages of this perforator-based flaps are the anatomical variation in the location of perforators and the need for technically careful dissection.
Humans ; Postoperative Complications ; Pressure Ulcer* ; Skin ; Walking ; Wounds and Injuries

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Reconstruction of median sternotomy dehiscence.

Jong Pil PARK ; Ji Won JEONG ; Young Jin SHIN ; Jae Hyeon YOO ; Myeong Hoon NA

Journal of the Korean Society of Plastic and Reconstructive Surgeons.1998;25(4):666-672.

Complications after a median sternotomy incision, which is used currently in most open heart surgery, are serious, although it is infrequent. Reconstruction of the sternal defect resulting from dehiscence of median sternotomy is still big challenge to the most plastic surgeons. Since vascularized greater omentum was transposed to eliminate mediastinal wound problems, many vascularized regional muscle flaps became mainstay in reconstruction of median sternotomy wound. We treated 13 patients with median sternotomy dehiscence between October of 1993 and March of 1998. In two patients, the wound problems were so confined to superficial tissue that debrided and closed primarily. Eleven patients with deep wound infection were managed with vigorous debridement of all necrotic tissues and resultant defects were covered with regional muscle flaps: rectus myocutaneous flap(3) and bilateral pectoralis advancement flap(8). We used the pectoralis major advancement flaps without counter incision at humeral insertion site and the dissections were limited only medial to the anterior axillary line to preserve the axillary fold. In five patients with larger defects, we elevated muscle and cutaneous flaps separately to make these flaps more mobile. Large portion of two rectus abdominis flaps could not survive, whereas pectoralis advancement flaps had mo special wound problems. Only one patient developed fistula due to remained wire, regardless to flap surgery.
Debridement ; Fistula ; Humans ; Omentum ; Rectus Abdominis ; Sternotomy* ; Thoracic Surgery ; Wound Infection ; Wounds and Injuries

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Facial reconstruction with submental island flap.

Jeong Tae KIM ; Seok Kwun KIM

Journal of the Korean Society of Plastic and Reconstructive Surgeons.1998;25(4):656-665.

The basic criteria of facial reconstruction with the flap are consisted of easy and wide applicability, good color and texture matching to the face and reliable anatomical basis. On these points, the submental island flap is superior to other regional flaps such as tissue expansion technique and free flaps It is based on the submental vessels branching from the facial vessels located at the medial groove of submandibular gland. Its pedicle has a reliable course along the inferior border of mandible with a constant distance and its perforator(s) is (are) located at the submental area around the anterior belly of digastric muscle. We report on its use in 4 cases of facial resurfacing on the cheek, the preauricular area and the nose in arteriovenous malformation and malignant skin cancer patients. The mylohyoid and anterior belly of digastric muscles could be included within the flap and the reverse submental island flap was also useful for obtaining the wide rotation of arc. The mean follow-up period was 8.3 months and the results were satisfactory to the patients. The submental island flap is reliable flap for facial resurfacing because of its good color and texture, acceptable donor scars, and thin, flexible flap. The flap also can incorperate with the skin, the muscle, and the bone in case of complicated facial defects. The long vascular pedicle also enables a wide applicability of the flap And also it can be used as a free flap, expanded flap and reverse island flap for the facial resurfacing.
Arteriovenous Malformations ; Cheek ; Cicatrix ; Follow-Up Studies ; Free Tissue Flaps ; Humans ; Mandible ; Muscles ; Nose ; Skin ; Skin Neoplasms ; Submandibular Gland ; Tissue Donors ; Tissue Expansion

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Orbitotemporal neurofibromatosis: a case report.

Jong Bong KANG ; Sung Hee HONG ; Jin KIM

Journal of the Korean Society of Plastic and Reconstructive Surgeons.1998;25(4):649-655.

Neurofibromatosis is an autosomal dominant abnormality that may affect multiple organ systems. The eyelids, the orbits, the adjacent tissues and bones may be involved with varying frequency and severity. The management of orbitotemporal neurofibromatosis depends very much on the type and severity of the orbital involvement and on the functional state of the eye. Experience with surgical management of orbitotemporal neurofibromatosis involved in the orbit, the temporal soft tissue and bone with blind eye is reported. The goal of surgery is tumor resection, reconstruction of the orbital socket, aesthetic eyelids, and insertion of the artificial prosthesis. A two stage approach is recommended. In the first stage, tumor is resected and the orbital socket is reconstructed with titanium mesh plate and cranial bone graft. After reconstruction of the orbital socket, galeal flap is rotated posteriorly to cover the mesh plate and canthopexy is accomplished. Mask lift is performed to enhance aesthetics. In the second stage, correction of the bulky eyelids is achieved and orbital space for insertion of the artificial prosthesis is reconstructed. Authors have managed a orbitotemporal neurofibromatosis with blind eye of a 41-year-old male using titanium mesh plate and bone graft with satisfactory results.
Adult ; Esthetics ; Eyelids ; Humans ; Male ; Masks ; Neurofibromatoses* ; Neurofibromatosis 1 ; Orbit ; Prostheses and Implants ; Titanium ; Transplants

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Full-thickness skin graft using the skin stretched by tissue expander.

Young Geun CHO ; Sung Pyo HONG ; Doo Hyung LEE

Journal of the Korean Society of Plastic and Reconstructive Surgeons.1991;18(4):669-675.

No abstract available.
Skin* ; Tissue Expansion Devices* ; Transplants*

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Facial reconstruction with cheek flap.

In Sik HONG ; Jeong Yun LEE ; Hee Chang AHN ; Yea Sik HAN

Journal of the Korean Society of Plastic and Reconstructive Surgeons.1991;18(4):662-668.

No abstract available.
Cheek*

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Treatment of the orbital dystopia associated with cavernous lymphangioma.

Ran Suk BANG ; Chul Hyun JUNG ; Ji Woon HA ; Young Cho KOH

Journal of the Korean Society of Plastic and Reconstructive Surgeons.1991;18(4):654-661.

No abstract available.
Lymphangioma* ; Orbit*

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