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A Patient with Multiple Unfavorable Reconstruction Options: What Is the Best Choice?.

Hyun June PARK ; Kyung Min SON ; Woo Young CHOI ; Ji Seon CHEON

Archives of Reconstructive Microsurgery.2016;25(2):75-78. doi:10.15596/ARMS.2016.25.2.75

The method of lower limb reconstruction surgery is selected based on a patient's underlying conditions, general conditions, and wound status, and it usually varies from direct closure to skin graft and flap coverage. Herein, we describe a patient with Duchenne muscular dystrophy who developed critical limb ischemia after femoral cannulation for extracorporeal membrane oxygenation was used during knee disarticulation, which was followed by reconstruction of the defect around the knee using a pedicled anterolateral thigh flap and skin graft.
Catheterization ; Disarticulation ; Extracorporeal Membrane Oxygenation ; Extremities ; Humans ; Ischemia ; Knee ; Lower Extremity ; Methods ; Muscular Dystrophy, Duchenne ; Skin ; Surgical Flaps ; Thigh ; Transplants ; Wounds and Injuries

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The Keystone Flap in Greater Trochanter Pressure Sore.

Il Hwan BYUN ; Soon Sung KWON ; Seum CHUNG ; Woo Yeol BAEK

Archives of Reconstructive Microsurgery.2016;25(2):72-74. doi:10.15596/ARMS.2016.25.2.72

The keystone flap is a fascia-based island flap with two conjoined V-Y flaps. Here, we report a case of successful treatment of a trochanter pressure sore patient with the traditional keystone flap. A 50-year-old male patient visited our department with a 3×5 cm pressure sore (grade III) to the left of the greater trochanter that was covered with eschar. Debridement was done and the defect size increased to 5×8 cm in an elliptical shape. Doppler ultrasound was then used to locate the inferior gluteal artery perforator near the wound. The keystone flap was designed to the medial side. The perforator based keystone island flap covered the defect without resistance. The site remained clean, and no dehiscence, infection, hematoma, or seroma developed. In general, greater trochanter pressure sores are covered with a perforator based propeller flap or fascia lata flap. However, these flaps have the risk of pedicle kinking and require a large operation site. For the first time, we successfully applied the keystone flap to treat a greater trochanter pressure sore patient. Our design was also favorable with the relaxation skin tension lines. We conclude that the keystone flap including a perforator is a reliable option to reconstruct trochanteric pressure sores.
Arteries ; Debridement ; Fascia Lata ; Femur* ; Hematoma ; Humans ; Male ; Middle Aged ; Pressure Ulcer* ; Relaxation ; Seroma ; Skin ; Ultrasonography ; Wounds and Injuries

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Perforator Based Tibialis Anterior Segmental Muscle Island Flap in Lower Extremity Reconstruction.

Il Hwan BYUN ; Soon Sung KWON ; Seum CHUNG ; Woo Yeol BAEK

Archives of Reconstructive Microsurgery.2016;25(2):69-71. doi:10.15596/ARMS.2016.25.2.69

Reconstruction of the lower extremities is difficult due to a lack of skin laxity and muscular tissues. Here, we present a case of lower extremity reconstruction via the anterior tibial artery perforator based segmental muscle island flap. Our patient was a 75-year-old male with a chronic ulcerative wound on the right lower leg from an old car accident. A 5.0×0.5 cm size ulcerative wound with tibial bone exposure was noted. We planned to reconstruct the lower extremity defect with a free flap, but the vessel status was severely compromised intraoperatively. Thus, we found the anterior tibial artery perforator using Doppler ultrasound, elevated the tibialis anterior muscle segment flap, and transposed it to cover the defect successfully. The flap presented with a nice contour and the skin graft covering the flap survived completely. There were no complications of the surgical site at three months follow-up and no gait morbidity. This is a meaningful case applying the concept of segmental muscle flap based on a perforator that had advantages including proper bulkiness, vascularization, and preservation of function, which were well applied, leading to great success.
Aged ; Follow-Up Studies ; Free Tissue Flaps ; Gait ; Humans ; Leg ; Lower Extremity* ; Male ; Perforator Flap ; Skin ; Tibial Arteries ; Transplants ; Ulcer ; Ultrasonography ; Wounds and Injuries

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Acute Shortening and Delayed Lengthening in Management of Lower Leg Amputation: A Case Report.

Seung Hoon KANG ; Sung Won JUNG ; Jin Woo JIN ; Dong Hee KIM ; Sung Jin SHIN ; Min JEONG ; Yil Ju EHO

Archives of Reconstructive Microsurgery.2016;25(2):65-68. doi:10.15596/ARMS.2016.25.2.65

Acute bone shortening and delayed lengthening by Ilizarov surgery have been used to treat a wide range of soft tissue injuries including open fracture, osteomyelitis of the tibia and lower leg amputation. It has advantages such as bone lengthening as well as minimizing the loss of damaged tissues via tissue expansion. Here, we report a case of 52-year-old male with satisfactory results through acute bone shortening, replantation, and gradual bone lengthening after complete amputation of the ankle with related literature reviews.
Amputation* ; Ankle ; Bone Lengthening ; Fractures, Open ; Humans ; Leg* ; Male ; Middle Aged ; Osteomyelitis ; Replantation ; Soft Tissue Injuries ; Tibia ; Tissue Expansion

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Replantation for Segmental Amputation of the Digits and Hand: A Case Report.

Sung Jin AN ; Sang Hyun LEE ; Hong Sung MIN ; In Hee KIM ; Jeung Il KIM

Archives of Reconstructive Microsurgery.2016;25(2):60-64. doi:10.15596/ARMS.2016.25.2.60

Segmental amputation of the digits and hand has been described as a contraindication for replantation because of poor results. We report the results of replantation for a patient who experienced multi-segment amputation of the hand. A 39-year-old man presented six hours after an accident, while using a straw cutter, that caused a multi-segment amputation of the entire palm and digits. The replantation surgery took 18 hours. We observed the patient gain satisfactory function of the hand. For replantation of a multi-segment amputation, connecting as many blood vessels as possible without tension is most important.
Adult ; Amputation* ; Blood Vessels ; Fingers ; Hand* ; Humans ; Replantation*

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Porocarcinoma Arising in a Ganglion Cyst: A Case Report and Review of the Literature.

Ie Hyon PARK ; Tae Hoon KIM ; Sung Tack KWON ; Ji Ung PARK

Archives of Reconstructive Microsurgery.2016;25(2):56-59. doi:10.15596/ARMS.2016.25.2.56

Eccrine porocarcinoma is a rare malignant neoplasm of the eccrine sweat gland that often occurs in the lower extremities, and usually affects elderly individuals. Most cases of eccrine porocarcinoma arise de novo. We encountered a case of a large porocarcinoma arising in a pre-existing ganglion cyst in the knee. The malignant tumor was excised widely, and the defect was reconstructed using a free anterolateral thigh flap.
Aged ; Eccrine Porocarcinoma ; Ganglion Cysts* ; Humans ; Knee ; Lower Extremity ; Sweat Glands ; Thigh

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Clinical Efficacy of Gluteal Artery Perforator Flaps for Various Lumbosacral Defects.

Hyun June PARK ; Kyung Min SON ; Woo Young CHOI ; Ji Seon CHEON

Archives of Reconstructive Microsurgery.2016;25(2):49-55. doi:10.15596/ARMS.2016.25.2.49

PURPOSE: Soft tissue defects in the lumbosacral area can be challenging to treat, and various methods to accomplish this have been proposed, including the use of perforator flaps. Herein, we present our experience with superior gluteal artery perforator (SGAP) and inferior gluteal artery perforator (IGAP) flaps for the reconstruction of lumbosacral defects. MATERIALS AND METHODS: From March 2013 to July 2016, 28 cases (27 patients) of lumbosacral defects were treated by reconstruction with SGAP or IGAP flaps. The defects were caused by pressure sores (21 cases), burns (3 cases), tumor resection (2 cases), scars (1 case), or foreign body infection (1 case). Reliable perforators around the defect were found using Doppler ultrasound. The perforator flaps were elevated with a pulsatile perforator and rotated to cover the defects. RESULTS: Twenty-three SGAP and 5 IGAP flap reconstructions were performed. The mean flap size was 9.2×6.1 cm² (range, 5×3 cm² to 16×10 cm²). Donor sites were closed by primary closure. Partial flap necrosis occurred in two cases, and minor complications of wound dehiscence occurred in 3 cases, which were healed by primary closure. The mean follow-up period was 4.4 months (range, 1~24 months). CONCLUSION: Gluteal-based perforator flaps can be safely harvested due to pliability and reliable vascularity in the gluteal area, reducing donor site morbidity without sacrificing the underlying muscles. Thus, these flaps are useful options for the reconstruction of lumbosacral defects.
Arteries* ; Burns ; Cicatrix ; Follow-Up Studies ; Foreign Bodies ; Humans ; Muscles ; Necrosis ; Perforator Flap* ; Pliability ; Pressure Ulcer ; Soft Tissue Injuries ; Tissue Donors ; Treatment Outcome* ; Ultrasonography ; Wounds and Injuries

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Hip Flexion during Intraoperative Insetting of a Perforator Flap for Reconstruction of an Ischial Sore.

Su Bong NAM ; Heung Chan OH ; Jae Woo LEE ; Kyeong Ho SONG ; Seong Hwan BAE

Archives of Reconstructive Microsurgery.2016;25(2):43-48. doi:10.15596/ARMS.2016.25.2.43

PURPOSE: Perforator flap-using ischial sore reconstruction is performed in a prone position. But after the surgery, recurrence frequently occurs in a sitting position. In this sense, we introduce modified flap insetting method which closely resembles patient's sitting position to lessen the flap tension surgically. MATERIALS AND METHODS: Authors tried to check a skin tension difference between prone position and sitting position in normal people group and to find out the importance of performing flap insetting in hip flexion position. Healthy volunteers were collected (n=20) and designed the same length of 4 divided sections around the ischium. Lengths of each section were measured when hip joint was flexed to 90 degree and when both hip and knee joints were flexed to 90 degree and the statistical evaluation was performed. Twenty cases with ischial sore underwent reconstructive surgery using perforator flap under hip flexion position and followed-up for any recurrences. RESULTS: There was a meaningful difference between the joint flexed skin length and that of the neutral position. Flap showed sufficient thickness over 12 months. CONCLUSION: It seems that recurrence could be reduced when the reconstructed flap could sufficiently cover in a sitting position regarding its significant length difference in normal people group.
Healthy Volunteers ; Hip Joint ; Hip* ; Ischium ; Joints ; Knee Joint ; Methods ; Perforator Flap* ; Pressure Ulcer ; Prone Position ; Recurrence ; Skin

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Close-by Islanded Posterior Tibial Artery Perforator Flap: For Coverage of the Ankle Defect.

Sujin BAHK ; SeungHwan HWANG ; Chan KWON ; Euicheol C JEONG ; Su Rak EO

Archives of Reconstructive Microsurgery.2016;25(2):37-42. doi:10.15596/ARMS.2016.25.2.37

PURPOSE: Soft tissue coverage of the distal leg and ankle region represents a surgical challenge. Beside various local and free flaps, the perforator flap has recently been replaced as a reconstructive choice because of its functional and aesthetic superiority. Although posterior tibial artery perforator flap (PTAPF) has been reported less often than peroneal artery perforator flap, it also provides a reliable surgical option in small to moderate sized defects especially around the medial malleolar region. MATERIALS AND METHODS: Seven consecutive patients with soft tissue defect in the ankle and foot region were enrolled. After Doppler tracing along the posterior tibial artery, the PTAPF was elevated from the adjacent tissue. The average size of the flap was 28.08±9.31 cm² (range, 14.25 to 37.84 cm²). The elevated flap was acutely rotated or advanced. RESULTS: Six flaps survived completely but one flap showed partial necrosis because of overprediction of the perforasome. No donor site complications were observed during the follow-up period and all seven patients were satisfied with the final results. CONCLUSION: For a small to medium-sized defect in the lower leg, we conducted the close-by islanded PTAPF using a single proper adjacent perforator. Considering the weak point of the conventional propeller flap, this technique yields much better aesthetic results as a simple and reliable technique especially for defects of the medial malleolar region.
Ankle* ; Arteries ; Follow-Up Studies ; Foot ; Free Tissue Flaps ; Humans ; Leg ; Necrosis ; Perforator Flap* ; Surgical Flaps ; Tibial Arteries* ; Tissue Donors

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Negative Pressure Wound Therapy Applied to a Meshed Split-Thickness Skin Graft.

Dong Hun LEE ; Yu Jin KIM

Archives of Reconstructive Microsurgery.2016;25(2):29-36. doi:10.15596/ARMS.2016.25.2.29

PURPOSE: Skin grafting is used for the transfer of cutaneous tissue from one site of the body to another. To improve graft survival, close contact between the graft and the wound bed is essential for vessels to grow across the gap. Here, we introduce an easy and efficient dressing method to improve graft survival. MATERIALS AND METHODS: A retrospective chart review was performed to identify patients who underwent split thickness skin graft and negative pressure wound therapy (NPWT) or conventional treatment between January 2007 and April 2015. Overall, 25 consecutive patients were included in the NPWT group and 49 were included in the conventional dressing group to compare the outcome of the procedure. The data were obtained from medical records, including age, sex, cause of the skin defect, size of graft, time for healing, wound preparation time, and complications. RESULTS: Of the NPWT group, the average wound size was 147.04±146.74 cm2 (range, 9~900 cm²). With the exception of one patient, all wounds healed without the need for further procedure. The average duration of time required for the NPWT group, which was defined as removal of stitches (or staples) and no need for additional active dressing, was 6.4±1.97 days (range, 5~15 days). The average time for the conventional dressing group was 10.78±2.38 days (range, 5~15 days). CONCLUSION: NPWT can be used to cover regions in which wound healing does not occur fully or when neither tie-over nor compressive dressings are applicable. This treatment also reduced wound healing time and allowed earlier patient mobilization and hospital discharge.
Bandages ; Graft Survival ; Humans ; Medical Records ; Methods ; Negative-Pressure Wound Therapy* ; Retrospective Studies ; Skin Transplantation ; Skin* ; Transplants* ; Wound Healing ; Wounds and Injuries

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