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Correction of Post Burn Extension Contracture of 4, 5th Toes Using Free Flap.

Soo Joong CHOI ; Jae Kyun JUNG ; Bong Cheol KWON ; Yong Beom LEE

Archives of Reconstructive Microsurgery.2013;22(2):90-93.

Old post burn contractures on feet still remain challenging problem for reconstructive surgeon. A 43-year-old male visited Hallym University Sacred Heart Hospital with the complain of foot deformity and difficulties in shoe fitting. His right 4th and 5th toes were inverted at dorsal foot. We released the contracture of 4, 5th metatarsophalangeal joint and lengthened extensor tendon by Z-plasty, and covered the resultant defect with the anterolateral thigh flap. The flap was successful and the deformity was corrected. As there have been few reports on reconstruction of foot dorsum, especially on post burn extension contractures in the toes, we report a rare case of contracture release and coverage by free flap.
Adult ; Burns* ; Congenital Abnormalities ; Contracture* ; Foot ; Foot Deformities ; Free Tissue Flaps* ; Heart ; Humans ; Male ; Metatarsophalangeal Joint ; Shoes ; Tendons ; Thigh ; Toes*

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Treatment of Recurrent Neuroma after Forearm Amputation: End to End Neurorrhaphy.

Youn Tae ROH ; Hyoung Min KIM ; Sung Lim YOU ; Chol Jin KIM ; Il Jung PARK

Archives of Reconstructive Microsurgery.2013;22(2):86-89.

The neuroma is a tumor of nerve tissue that partially or completely severed through incomplete regeneration process. Neuromas that formed in the stump of a limb following amputation is a cause of the stump pain and can make intractable pain. The authors report a rare case of 36-year-old man with neuroma at stump, which has been recurred three times. This patient was treated with end-to-end neurorrhaphy after resecting neuroma. Follow-up at out-patient clinic showed satisfied result.
Adult ; Amputation* ; Extremities ; Follow-Up Studies ; Forearm* ; Humans ; Nerve Tissue ; Neuroma* ; Outpatients ; Pain, Intractable ; Regeneration

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Heterodigital Free Flap of Index Finger Amputee for Coverage of the Long Finger Soft Tissue Defect.

So Min HWANG ; Jang Hyuk KIM ; Hong Il KIM ; Yong Hui JUNG ; Hyung Do KIM

Archives of Reconstructive Microsurgery.2013;22(2):82-85.

If the replantation on the original position is not possible, the amputated tissue of a hand may be used as a donor for recovering hand functions at other positions. This procedure is termed 'heterodigital replantation'. An 63-year-old male patient who was in press machine accident came to our hospital. He had large dorsal soft-tissue defects (5x3 cm) on his left long finger and complete amputation on his left index finger through the proximal interpharyngeal joint. Replantation was not indicated because crushing injury of index finger was severe. So we decided to use index finger soft tissue as heterodigital free flap for the coverage of the long finger defect. The ulnar digital artery and dorsal subcutaneous vein of the free flap were anastomosed with the radial digital artery and dorsal subcutaneous vein of the long finger. The heterodigital free flap provided satisfactory apperance and functional capability of the long finger. The best way to treat amputation is replantation. But sometimes surgeon confront severely crushed or multi-segmental injured amputee which is not possible to replant. In this situation, reconstructive surgeons should consider heterodigital free flap from amputee as an option.
Amputation ; Amputees* ; Arteries ; Fingers* ; Free Tissue Flaps* ; Hand ; Humans ; Joints ; Male ; Middle Aged ; Replantation ; Tissue Donors ; Veins

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A Solitary Neurofibroma of the Small Finger Associated with Trauma.

Hwan Jun CHOI ; Kyu Hwa JUNG ; Doo Hyun NAM

Archives of Reconstructive Microsurgery.2013;22(2):78-81.

Neurofibroma may present as a solitary lesion or as multiple lesions. Although there is no site of predilection for solitary lesions, occurrence on the hand is rare. Plexiform neurofibroma can develop in isolation or more commonly as a part of neurofibromatosis type 1. In those that apper in isolation, trauma has been suggested as a precipitating factor. A 68-year-old male farmer had experienced repetitive prior episodes of trauma in the involved finger. He presented with a painless mass on the dorsal aspect of the fifth finger. Physical examination showed a protruding mass measuring approximately 15x20 mm which was not tenderness to palpation and any skin changes or pigmentation. Ultrasonography showed a cystic mass on the dorsal aspect of the middle phalanx. Microsurgical dissection was applied in order to seperated the lesion from the ulnar side of the dorsal branch of the digital nerve. Pathologic examination of the specimens revealed neurofibroma. At three-month follow-up, motor and sensory function were intact, and range of motion was fully recovered. Traumatic solitary neurofibroma is a rare tumor of the hand, especially in the finger. Hand surgeons should be aware of the diagnostic possibilities of this tumor based on examination, history taking and imaging studies.
Aged ; Fingers* ; Follow-Up Studies ; Hand ; Humans ; Male ; Neurofibroma* ; Neurofibroma, Plexiform ; Neurofibromatosis 1 ; Palpation ; Physical Examination ; Pigmentation ; Precipitating Factors ; Range of Motion, Articular ; Sensation ; Skin ; Ultrasonography

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A Superior Ulnar Collateral Artery Perforator Flap for a Large Defect on the Posterior Upper Arm.

Ho Jin PARK ; Eul Sik YOON

Archives of Reconstructive Microsurgery.2013;22(2):74-77.

A patient underwent reconstruction of skin and soft tissue using V-Y advancement of a superior ulnar collateral artery perforator flap after resection of the scar tissue on the upper arm. Successful flap healing was observed without complications. The medial side of the upper arm is an ideal donor site because of its thin, elastic, and hairless skin, resulting in a well-hidden scar. The elasticity of the medial side of the upper arm allows primary closure after flap elevation. The superior ulnar collateral artery perforator flap is an option for reconstruction of the upper arm.
Arm* ; Arteries* ; Cicatrix ; Elasticity ; Humans ; Perforator Flap* ; Skin ; Tissue Donors

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Microsurgical Approach for Root Coverage of Receding Gingiva in the Esthetic Zone.

Ranjana MOHAN ; Rohit JAIN

Archives of Reconstructive Microsurgery.2013;22(2):69-73.

Facial esthetics and smiling are key components in nonverbal communication and have an important role in determination of the first impression of a person. The various components of the smile in dental esthetics include Gingival scaffold, lip framework, and Teeth. The periodontist creates a smile by performing various periodontal plastic microsurgery procedures for management of mucogingival problems. A 25-year-old patient reported to the Department of Periodontology at Teerthanker Mahaveer Dental College and Research Center, Moradabad, Northern India, with the chief complaint of long looking teeth in the upper jaw, making him conscious while smiling. Miller class I gingival recession with Maxillary left canine (23) was diagnosed. Periodontal plastic microsurgery employing double papilla grafting with connective tissue graft harvested from the palate in order to cover denuded root was performed using microsurgical instruments and microsuturing with 6-0 suturing material under magnification. Healing was uneventful, with achievement of 100% root coverage of denuded root after three months. The patient was highly impressed and satisfied with his enhanced smile.
Adult ; Connective Tissue ; Esthetics ; Esthetics, Dental ; Gingiva* ; Gingival Recession ; Humans ; India ; Jaw ; Lip ; Microsurgery ; Nonverbal Communication ; Palate ; Plastics ; Smiling ; Tooth ; Transplants

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Free Flap Coverage of the Finger Defect Caused by Digital Replantation Failure.

Jung Hwan SHIM ; Seong Ho JEONG

Archives of Reconstructive Microsurgery.2013;22(2):63-68.

PURPOSE: In case of the failed replantation, if the patients want to preserve the length of amputated stump, toe transfer is the ideal choice. However, reconstruction of these amputated stump with a free flap can be a useful method when the patients refuse sacrificing their toe. Our purpose of this study is to evaluate availability of functional results and patient satisfaction after this procedure. MATERIALS AND METHODS: From March 2008 to February 2012, we reconstructed the amputated stump with free flap by patients demand. Eleven patients were included, medial plantar artery perforator flap in seven cases and great toe pulp flap in five cases. Follow-up range 12 to 24 months and we evaluate patient satisfaction by using a visual analogue scale (VAS; 1=unsatisfied, 5=excellent) and functional recovery by measuring the range of motion of remaining joint at 12 months after operation. RESULTS: During follow-up period, all transferred free flaps survived and no major complications were noted. Range of motion of remaining joint appeared satisfactory result (15degrees to 100degrees). The VAS patient satisfaction score for aesthetic were five in six patients, four in four patients, and three in one patient. CONCLUSION: In case of the failed digital replantation, if patient refuse toe transfer, it could be useful method to reconstruction with the free flap to preserving maximal length of amputated stump.
Arteries ; Fingers* ; Follow-Up Studies ; Free Tissue Flaps* ; Humans ; Joints ; Patient Satisfaction ; Perforator Flap ; Range of Motion, Articular ; Replantation* ; Toes

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Reconstruction of Large Bone and Soft Tissue Defect Combined with Infection in the Lower Extremity with Free Flap Followed by Ipsilateral Vascularized Fibular Transposition.

Duke Whan CHUNG ; Chung Soo HAN ; Jae Hoon LEE ; Eun Yeol KIM ; Kwang Hee PARK ; Dong Kyoon KIM

Archives of Reconstructive Microsurgery.2013;22(2):57-62.

PURPOSE: The aim of this study is to report on the results and discuss the role of free flap followed by ipsilateral vascularized fibular transposition (IVFT) for reconstruction of large bone and soft tissue defect combined with infection by open tibia fracture. MATERIALS AND METHODS: During the research period, lasting from December 2002 to June 2008 (Kyung Hee University Medical Center), data were collected from three patients who underwent IVFT after free flap. We analyzed the successiveness and persistency of the infection using free flapping, bone union, and hypertrophy between transposed fibula and tibia. RESULTS: Regarding free flap, successive results were observed in all examples. In the final follow-up results, transposed fibulas all survived, having hypertrophy similar to that of adjacent tibia. CONCLUSION: Reconstruction of tibia defect with free flap followed by IVTF is a useful and safe method for avoidance of the potential risk of infection for patients with a large tibial bone defect and soft tissue defect associated with infection.
Fibula ; Follow-Up Studies ; Free Tissue Flaps* ; Humans ; Hypertrophy ; Lower Extremity* ; Methods ; Tibia

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Ipsilateral Dorsalis Pedis Vascularized Pedicle Flap in the Distal Leg and Foot.

Chang Eun YU ; Jun Mo LEE ; Hee Rack CHOI

Archives of Reconstructive Microsurgery.2013;22(2):52-56.

PURPOSE: We had proceeded seven iIpsilateral dorsalis pedis vascularized pedicle flaps in the distal leg and foot to cover the restricted size defects and followed-up average for 5 years and 9 months to evaluate the survival rate, neurosensory function and cosmesis in final results. MATERIALS AND METHODS: From January 1999 through October 2012, we have performed iIpsilateral dorsalis pedis vascularized pedicle flaps in the distal leg and foot to cover the restricted size defect (average around 3.6x2.4 cm) in 7 cases and average age was 41.6 years (21.5 to 59.0 years). Lesion site was posterior heel in 4 cases, distal anterior leg in 3 cases. Donor structure was the dorsalis pedis artery and the first dorsal metatarsal vessel and deep peroneal nerve in 3 cases and the dorsalis pedis artery and the first dorsal metatarsal vessel in 4 cases. RESULTS: Seven cases (100%) were survived and defect area was healed with continuous dressing without skin graft. The sensory function in the neurovascular flap was restored to normal in 3 cases. Cosmesis was good and fair in 7 cases (85.7%). CONCLUSION: Ipsilateral dorsalis pedis vascularized pedicle flap in the distal leg and foot is one of the choice to cover the exposed bone and soft tissues without microsurgical procedure.
Ankle ; Arteries ; Bandages ; Foot* ; Heel ; Humans ; Leg* ; Metatarsal Bones ; Peroneal Nerve ; Sensation ; Skin ; Surgical Flaps ; Survival Rate ; Tissue Donors ; Transplants

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Traumatic Epidermal Inclusion Cyst under Anterolateral Thigh Free Flap on Great Toe.

Jun Ho LEE ; Hwan Jun CHOI

Archives of Reconstructive Microsurgery.2015;24(1):37-39. doi:10.15596/ARMS.2015.24.1.37

Epidermal inclusion cyst is a common mass in life. It is covered with a stratified squamous epithelium, thus, there is a granular cell layer adjacent to the keratin-containing cyst lumen. It can be caused by mechanical force, trauma, or a spontaneous event. It can rupture spontaneously or be ruptured by external mechanical forces. Epidermal inclusion cysts that exhibit inflammation or recur should be removed by simple excision. In this case, the patient showed an epidermal inclusion cyst under an anterolateral thigh free flap, which can cause the palpable mass to go unnoticed. First we thought he had neuroma formation after a surgical procedure on his foot. However it was an epidermal inclusion cyst, which was diagnosed by a special pathologist. It is a curious and rare case.
Epithelium ; Foot ; Free Tissue Flaps* ; Humans ; Inflammation ; Neuroma ; Rupture ; Thigh* ; Toes*

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