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Pedicled Perforator Flaps for Reconstruction of Bilateral Knee Defects: A Case Report.

Joo Seok PARK ; Joon Pio HONG ; Tae Suk OH

Archives of Reconstructive Microsurgery.2014;23(2):101-104. doi:10.15596/ARMS.2014.23.2.101

Reconstruction of soft tissue defects of the knee has always been a challenging task for plastic surgeons. Various reconstructive choices are available depending on the location, size, and depth of the defect relative to the knee joint. Defects on the knee joint have several characteristic features. The use of a free flap is preferred for reconstructions involving obliteration of large-cavity defects, but recipient pedicle isolation can be difficult because of the extent of the injury zone. Furthermore, the true defect during knee joint flexion is larger than during knee joint extension, and a durable flap is necessary for joint movement. We report for the first time on the use of pedicled perforator flaps for reconstruction of bilateral knee defects in a 76-year-old woman. The operative procedure required skeletonizing the perforators of an antero-lateral thigh flap and antero-medial thigh flap and rotating the flap in the defect. The patient returned to normal daily activity and had a full range of motion two months after the accident. The shorter operating time with decreased donor site morbidity and its durability make this flap a valuable alternative for soft tissue reconstruction of the knee.
Aged ; Female ; Free Tissue Flaps ; Humans ; Joints ; Knee Joint ; Knee* ; Perforator Flap* ; Range of Motion, Articular ; Skeleton ; Surgical Flaps ; Surgical Procedures, Operative ; Thigh ; Tissue Donors

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Arteriovenous Fistula Formation Using Microscope Rather than Surgical Telescope.

Byeong Ho LEE ; In Suck SUH ; A Jin CHO ; Jung Woo NOH ; Hii Sun JEONG

Archives of Reconstructive Microsurgery.2014;23(2):97-100. doi:10.15596/ARMS.2014.23.2.97

The number of patients with chronic renal failure who require renal replacement therapy is increasing and dialysis is still the mainly used renal replacement therapy. The first choice of surgical technique currently used is side-to-end anastomosis of the radial artery and the cephalic vein. The authors report on a case of an effective arteriovenous shunt operation performed using microscopy. A 53-year-old male with chronic renal failure was referred to plastic and reconstructive surgery department to undergo an arteriovenous shunt operation. Venography was performed before surgery in order to find the appropriate vessel for the arteriovenous shunt operation. The cephalic vein on the wrist showed a diameter of over 4 mm, which was appropriate for an arteriovenous shunt operation. Anastomosis of the vessels was performed under microscopy using Nylon #9-0. Blood flow and vessel diameter were evaluated by venography after surgery and showed well maintained function of the shunt. Complications such as bleeding, edema of the upper arm, and wound dehiscence did not occur. Many factors and certain complications may affect the long-term patency of an arteriovenous shunt; however, exquisite surgical technique is the most important factor in a successful operation. Thus, arteriovenous shunt operation using microscopy is thought to be a good treatment option.
Arm ; Arteriovenous Fistula* ; Dialysis ; Edema ; Hemorrhage ; Humans ; Kidney Failure, Chronic ; Male ; Microscopy ; Middle Aged ; Nylons ; Phlebography ; Plastics ; Radial Artery ; Renal Replacement Therapy ; Telescopes* ; Veins ; Wounds and Injuries ; Wrist

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Diagnosing Micro Foreign Bodies with the Microscope.

Chan KWON ; Seung Chul RHEE ; Su Jin BAHK ; Sang Hun CHO ; Su Rak EO

Archives of Reconstructive Microsurgery.2014;23(2):93-96. doi:10.15596/ARMS.2014.23.2.93

The microscope is a surgical instrument with wide use in plastic surgeries more often than other departments due to the high rate of microscopic surgeries. Unfortunately, because the microscope is used mainly for digital replantations and free flaps, the utilization rate is low compared to the price and usability of the microscope itself. From September 2013 to March 2014, a foreign body which was untraceable with radiology in a patient who desired surgical exploration (one case), and a foreign body which was detected but was smaller than 3 mm (two cases) were removed using the microscope. All foreign bodies, which were fish bone, thin metals, or wooden objects, matching the history of the patients, were completely removed without damage. There were no complications and patient satisfaction was high through follow-up. We have described the microscope as the last and optimal examination tool in removal of micro foreign bodies. A simple change of thought, so that the microscope can be used as a second diagnostic tool will decrease complications by foreign bodies.
Follow-Up Studies ; Foreign Bodies* ; Free Tissue Flaps ; Humans ; Metals ; Microscopy ; Patient Satisfaction ; Replantation ; Surgical Instruments

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Chest Wall Reconstruction with a Transverse Rectus Abdominis Musculocutaneous Flap in an Extremely Oversized Heart Transplantation.

Ji Hong YIM ; Jin Sup EOM ; Deok Yeol KIM

Archives of Reconstructive Microsurgery.2014;23(2):89-92. doi:10.15596/ARMS.2014.23.2.89

An 8-year-old girl diagnosed with dilated cardiomyopathy and Russell-Silver syndrome was admitted to our pediatric intensive care unit due to low cardiac output and multiple-organ dysfunction. The patient was placed on the heart transplant waiting list and extracorporeal membrane oxygenation was performed as a bridge to transplantation. After 17 days, heart transplantation was performed. The donor was a 46-year-old female (weight, 50 kg; height, 150 cm). The donor:recipient weight ratio was 3.37:1. Because the dimension and volume of the recipient's thoracic cage were insufficient, the sternum could not be closed. Nine days after transplantation, the patient underwent delayed sternal closure. To obtain adequate space, we left the sternum 4.5 cm apart from each margin using four transverse titanium plates. A transverse rectus abdominis musculocutaneous flap was chosen to cover the wound. Due to the shortage of donors, a size-mismatched pediatric heart transplantation is sometimes unavoidable. Closure of the opened sternum of a transplant recipient can be challenging. Sternal reconstruction after an extremely oversized heart transplantation with transverse titanium plate fixation and a musculocutaneous flap can effectively achieve sternal closure and stability.
Cardiac Output, Low ; Cardiomyopathy, Dilated ; Child ; Extracorporeal Membrane Oxygenation ; Female ; Heart ; Heart Transplantation* ; Humans ; Intensive Care Units ; Middle Aged ; Myocutaneous Flap* ; Rectus Abdominis* ; Silver-Russell Syndrome ; Sternum ; Thoracic Wall* ; Tissue Donors ; Titanium ; Transplantation ; Waiting Lists ; Wounds and Injuries

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A Schwannoma Originating from Median Nerve at Proximal Forearm Caused Ulnar Nerve Symptom by Compression.

Jeong Hyun YOO ; Joon Yub KIM ; Hyoung Soo KIM ; Joo Hak KIM ; Ki Hyuk SUNG ; Sang Hun SONG ; Ho Il KWAK

Archives of Reconstructive Microsurgery.2014;23(2):86-88. doi:10.15596/ARMS.2014.23.2.86

A schwannoma is a benign soft tissue tumor arising from the nerve sheath of a Schwann cell. Clinically, a schwannoma is an asymptomatic mass rarely causing neurologic deficits. However, it can cause discomfort as well as motor and sensory disturbances by compressing the nerve of its origin. The authors encountered a huge schwannoma arising from the median nerve at the proximal forearm, which caused symptoms mainly in the ulnar nerve. The tingling sensation along the ulnar nerve disappeared completely after enucleation of the schwannoma originating from the median nerve.
Forearm* ; Median Nerve* ; Neurilemmoma* ; Neurologic Manifestations ; Sensation ; Ulnar Nerve*

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The Functional Results of Forearm and Upper Arm Replantation: Report on Two Cases.

Chang Eun YU ; Young Ju CHAE ; Jun Mo LEE

Archives of Reconstructive Microsurgery.2014;23(2):82-85. doi:10.15596/ARMS.2014.23.2.82

Upper extremity replantation is relatively less commonly performed than finger or hand replantation. We have experienced one case of forearm replantation and one case of upper arm replantation. After the replantation, limb volume at the biceps brachii muscle level below the replantation level appeared to be appropriate, however, the motor function of the muscles and the sensitivity were disappointing. For replantation of forearm and upper arm, restoration of the motor function and sensitivity of the extremity below the amputation level as well as the morphologic reconstruction have to be considered.
Amputation ; Arm* ; Extremities ; Fingers ; Forearm* ; Hand ; Muscles ; Replantation* ; Upper Extremity

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Reconstruction of the Soft Tissue Defect on Anteromedial Surface of the Leg Using Medial Hemisoleus Flap.

Il Jung PARK ; Yoo Joon SUR ; Sung Lim YOU

Archives of Reconstructive Microsurgery.2014;23(2):76-81. doi:10.15596/ARMS.2014.23.2.76

PURPOSE: Anteromedial surface of the leg is susceptible to trauma, which frequently induces soft tissue defect. When the size of a soft tissue defect is small to moderate, a local muscle flap is an easy and reliable alternative to a free flap. The authors performed medial hemisoleus flaps for reconstruction of soft tissue defects on the anteromedial surface of legs. The aim of this study was to evaluate clinical outcomes and effectiveness of the medial hemisoleus flap. MATERIALS AND METHODS: Twelve patients underwent the medial hemisoleus flap for reconstruction of a soft tissue defect on the anteromedial surface of the leg from February 2009 to December 2013. There were eight males and four females with a mean age of 47.8 years (15 to 69 years). The mean size of defects was 4.7x4.2 cm (2x2 to 9x6 cm). Flap survival and postoperative complications were evaluated. RESULTS: Mean follow-up period was 39.6 months (7 to 64 months) and all flaps survived. There were two cases of negligible necrosis of distal margin of the flap, which were healed after debridement. All patients were capable of full weight bearing ambulation at the last follow-up. CONCLUSION: The medial hemisoleus flap is a simple, reliable procedure for treatment of a small to moderate sized soft tissue defect on the anteromedial surface of the leg.
Debridement ; Female ; Follow-Up Studies ; Free Tissue Flaps ; Humans ; Leg* ; Male ; Necrosis ; Postoperative Complications ; Soft Tissue Injuries ; Walking ; Weight-Bearing

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Soft Tissue Reconstruction Using Perforator Flap in Patients with Infected Knee Prosthesis.

Jin Won LEE ; Sung Hoon KIM ; Jun Ho YOO ; Si Gyun ROH ; Nae Ho LEE ; Kyoung Moo YANG

Archives of Reconstructive Microsurgery.2014;23(2):70-75. doi:10.15596/ARMS.2014.23.2.70

PURPOSE: Soft-tissue reconstruction in the knee area requires thin, pliable, and tough skin. The range of motion of the knee also acts as a limitation in using only local flaps for coverage. The author has successfully used various perforator flaps for soft tissue reconstruction around the knee while preserving its functional and cosmetic characteristics. MATERIALS AND METHODS: Out of the twenty patients assessed from April 2009 to March 2011, seven received anterolateral thigh perforator flaps, four received medial sural perforator island flaps, four received lateral supragenicular perforaor perforator flaps, and five received medial genicular artery flaps. The age of the patients ranged from 44 to 79 and the size of the defects ranged from 4x5 cm to 17x11 cm. Fifteen of the twenty patients had histories of total knee replacement (TKR) surgery. RESULTS: There were no flap losses in any of the twenty patients assessed. Two patients showed partial losses in the distal area of the flap, but were treated through careful wound care. One patient presented with pedicle adhesion at the drainage site from a past TKR, but it did not hinder the flap survival. Primary closure at the donor site was possible in nine patients, while split skin graft was necessary for the other 13. CONCLUSION: In soft tissue reconstruction of the knee, various perforator flaps can be used depending on the condition of the preoperation scar, wound site, and size. It also proved to provide better functional and cosmetic results than in primary wound closure or skin grafts.
Arteries ; Arthroplasty, Replacement, Knee ; Cicatrix ; Drainage ; Humans ; Knee ; Knee Prosthesis* ; Perforator Flap* ; Range of Motion, Articular ; Reconstructive Surgical Procedures ; Skin ; Surgical Flaps ; Thigh ; Tissue Donors ; Transplants ; Wounds and Injuries

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Reconstruction of Distal Phalangeal Soft Tissue Defects with Reverse Homodigital Artery Island Flap.

Byung Gook KIM ; Soo Hong HAN ; Ho Jae LEE ; Soo Hyun LEE

Archives of Reconstructive Microsurgery.2014;23(2):65-69. doi:10.15596/ARMS.2014.23.2.65

PURPOSE: Soft tissue reconstruction is essential for recovery of finger function and aesthetics in any traumatic defect. The authors applied a reverse homodigital artery island flap for soft tissue defect on distal part of digits. The aim of this study is to evaluate the efficacy of the procedure. MATERIALS AND METHODS: Seven cases of soft tissue defects of finger tip were included in this study. There were six male and one female, mean age was 43 years and mean follow-up period was 38 months. The length of flaps ranged from 2.0 to 2.5 cm and width ranged from 1.0 to 2.0 cm. Flap survival, postoperative complications were evaluated. RESULTS: All flaps survived without loss. Donor sites were repaired with primary closure in five cases and skin graft in two cases. None of the patients showed significant complications and their average finger motion was 255degrees in total active motion at the last follow-up. CONCLUSION: The authors suggest that the reverse homodigital artery island flap could be a versatile treatment option for the soft tissue defect on distal part of digits.
Arteries* ; Esthetics ; Female ; Fingers ; Follow-Up Studies ; Humans ; Male ; Postoperative Complications ; Skin ; Soft Tissue Injuries ; Tissue Donors ; Transplants

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Necrotic Complications in Nipple-Sparing Mastectomy Followed by Immediate Breast Reconstruction: Systematic Review with Pooled Analysis.

Kyeong Tae LEE ; Goo Hyun MUN

Archives of Reconstructive Microsurgery.2014;23(2):51-64. doi:10.15596/ARMS.2014.23.2.51

This study provides a systematic review of the literature on nipple-sparing mastectomy and necrotic complications in order to estimate the prevalence of necrotic complications and to investigate their significant predictors. A literature search was conducted using the MEDLINE and Ovid databases. A pooled analysis was performed for calculation of the prevalence of nipple-areolar complex (NAC) necrosis, mastectomy flap necrosis, and overall necrotic complications and to evaluate the relationships between necrotic complications and potential risk factors. A total of 44 papers were analyzed. The prevalence of overall necrotic complications was 13.7%, including 7.5% for NAC necrosis and 7.8% for mastectomy flap necrosis. Types of incisions showed significant association with the rates of NAC necrosis and mastectomy flap necrosis. Incisions involving the NAC showed a significantly higher rate of NAC necrosis than those not involving it. The prevalence of NAC necrosis was higher in the autologous tissue reconstruction group than in the prosthesis group. Active smoking and diathermy dissection were significant predictors of both NAC necrosis and mastectomy flap necrosis. The findings of this review suggest that there are several predictors of necrotic complications in nipple-sparing mastectomy. Appropriate patient selection, careful operative planning, and surgical technique refinements may reduce the risk of necrotic complications.
Diathermy ; Female ; Mammaplasty* ; Mastectomy* ; Necrosis ; Patient Selection ; Postoperative Complications ; Prevalence ; Prostheses and Implants ; Risk Factors ; Smoke ; Smoking

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