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Using the Dorsal Metacarpal Artery Perforator Flap for Reconstruction of Rheumatoid Ulcers.

Min CHOI ; Kyung Min SON ; Woo Young CHOI ; Ji Seon CHEON ; Jeong Yeol YANG

Archives of Reconstructive Microsurgery.2015;24(2):79-81. doi:10.15596/ARMS.2015.24.2.79

Rheumatoid arthritis is a long lasting autoimmune disorder that primarily affects joints, and patients with rheumatoid arthritis are predisposed to development of chronic skin ulcers. In addition, skin ulcers with rheumatoid arthritis tend to persist despite treatment because of sustained inflammation and poor healing capacity. Treatment of skin ulcers involves medications, wound coating agents, and surgical procedures including skin grafting, however, wound dressing or skin grafts are generally excluded because of excessive cost and time and poor intake rate. The dorsal metacarpal artery perforator (DMAP) flap, a vascular island flap for coverage of soft tissue defects on the fingers, provides promising results including matched quality and color. We experienced a case of DMAP flap for reconstruction of a rheumatoid ulcer, and a DMAP flap may be considered as a good faithful option for treatment of patients with rheumatoid ulcer.
Arteries* ; Arthritis, Rheumatoid ; Bandages ; Fingers ; Humans ; Inflammation ; Joints ; Perforator Flap* ; Skin ; Skin Transplantation ; Skin Ulcer ; Transplants ; Ulcer* ; Wounds and Injuries

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Reconstruction of High-Pressure Paint Gun Injection Injured Finger Using Free Flaps with T-Shaped Pedicles and Multiple Venous Anastomoses.

Jun Beom LEE ; Hwan Jun CHOI ; Jun Hyuk KIM ; Nam Ju CHEON ; Young Man LEE

Archives of Reconstructive Microsurgery.2015;24(2):75-78. doi:10.15596/ARMS.2015.24.2.75

High-pressure (HP) injection injury to the upper extremity often causes a very serious clinical problem, leading to poor outcomes, including amputation, so that a true surgical emergency is required. The outcomes can be improved with emergent wide surgical debridement. However the diagnosis of these injuries is often delayed due to underestimated evaluation at first appearance and lack of common knowledge of the seriousness of this injury. The type and pressure of the infecting material is an important factor in prognosis and organic solvents infected pressure injury can cause poor outcome and increased amputation rate. In this case, we report on reconstruction of HP oilbased paint injection injuries of the finger using T-shaped pedicles and multiple venous anastomoses. In this concept, arterial flow can be maintained by the reverse flow of distal anastomosis when there is difficulty with the proximal anastomosis. And venous flow can be preserved by deep and superficial vein anastomosis. This concept has various advantages including preserving patency of the pedicle in chronic vasculopathy or trauma cases and maintaining the arterial flow by the reverse flow of distal anastomosis and can improve the free flap survival by a two vascular anastomosis system.
Amputation ; Debridement ; Diagnosis ; Emergencies ; Fingers* ; Free Tissue Flaps* ; Paint* ; Prognosis ; Solvents ; Upper Extremity ; Veins

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Reconstruction of Large Femur and Tibia Defect with Free Vascularized Fibula Graft and Locking Plate.

Min Bom KIM ; Young Ho LEE ; Jeong Kook BAEK ; Ho Sung CHOI ; Goo Hyun BAEK

Archives of Reconstructive Microsurgery.2015;24(2):68-74. doi:10.15596/ARMS.2015.24.2.68

PURPOSE: The reconstruction of femur and tibia defects following tumor resection remains a surgical challenge. The clinical outcome of free vascularized fibula graft (VFG) reconstruction with locking plate for massive femur and tibia defects of more than 10 cm that were secondary to skeletal tumor resection is reported. MATERIALS AND METHODS: Thirteen patients with a mean follow-up of 3.3 years were reviewed. Seven patients received vascularized fibula grafts in the femur and six in the tibia. The mean bony defect of the femur and tibia was more than 10 cm and the length of the grafted fibula was more than 15 cm. All defects were stabilized with long locking plates. RESULTS: All patients were free of disease at final follow-up; All VFGs were transferred successfully. All patients had a successful outcome with bony union. Stress fractures of the grafted fibula had occurred but the locking plate stabilized the fracture and healed until the last follow-up. All patients were able to walk without a brace after a mean of 9 months postoperatively. CONCLUSIONS: VFG with locking plate is a reliable reconstructive procedure for massive femur and tibia defects.
Braces ; Femur* ; Fibula* ; Follow-Up Studies ; Fractures, Stress ; Humans ; Tibia* ; Transplants*

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Pollicization of the Middle Finger.

Sujin BAHK ; Su Rak EO ; Sang Hun CHO ; Neil Ford JONES

Archives of Reconstructive Microsurgery.2015;24(2):62-67. doi:10.15596/ARMS.2015.24.2.62

PURPOSE: Pollicization typically involves surgical migration of the index finger to the position of the thumb. This procedure facilitates the conversion of a useless hand into a well-functioning one in patients who are not amenable to the toe-to-hand transfer. However, middle finger pollicization has been rarely reported. MATERIALS AND METHODS: We reconstructed a thumb by immediate pollicization of the remnants of the middle finger in two patients who sustained a tumor and a trauma, respectively. The former, after cancer ablation was performed, has not been reported literally, and the latter involved free devitalized pollicization of the middle finger using a microsurgical anastomosis. The distal third extensor communis tendon was sutured to the proximal extensor pollicis longus tendon and the distal flexor digitorum superficialis and profundus were sutured to the proximal flexor pollicis longus. The abductor pollicis brevis tendon was sutured to the distal end of the first palmar interosseous muscle. Coaptation of the third digital nerve and the superficial radial nerve branch was performed. RESULTS: Patients showed uneventful postoperative courses without complication such as infection or finger necrosis. Based on the principles of pollicization, a wide range of pinch and grasp movements was successfully restored. They were pleased with the functional and cosmetic results. CONCLUSIONS: Although the index finger has been the digit of choice for pollicization, we could also use the middle finger on specific occasions. This procedure provides an excellent option for the reconstruction of a mutilated thumb and could be performed advantageously in a single step.
Fingers* ; Hand ; Hand Strength ; Humans ; Necrosis ; Radial Nerve ; Tendons ; Thumb

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Diatally-Based Medial Crural Adipofascial Flap for Coverage of Medial Foot and Ankle.

Min Bom KIM ; Young Ho LEE ; Ho Sung CHOI ; Dong Hwan KIM ; Jung Hyun LEE ; Goo Hyun BAEK

Archives of Reconstructive Microsurgery.2015;24(2):56-61. doi:10.15596/ARMS.2015.24.2.56

PURPOSE: We report on the clinical result after coverage of a soft tissue defect on the medial foot and ankle with an adipofascial flap based on the perforator from the posterior tibia artery. MATERIALS AND METHODS: Nine patients with soft tissue defects on the medial foot and ankle area from March 2009 to May 2014 underwent the procedure. Average age was 54 years old (range, 8~82 years). There were five male patients and four female patients. The causes of the defect were trauma (4), tumor (3), and infection (2). The pivot point of transposition of this flap is the lower perforator originating from the posterior tibia artery. The fatty tissue side of this flap could be used to resurface the defect. The donor site was closed primarily with the preserved skin, and a small caliber drain tube was used. The split-thickness skin graft was grafted to the flap and the wound. If the wound was still infected, this skin graft could be performed at a later date. RESULTS: All flaps survived and normal soft tissue coverage was obtained for the medial foot and ankle of all patients after the skin graft. Normal footwear was possible for all cases because of thin coverage. There was an extension contracture on the medial ray of the foot, which was resolved by contracture release and skin graft. CONCLUSIONS: For the medial foot and ankle soft tissue defect, the medial crural adipofascial flap based on a perforator branch of the posterior tibia artery could be a good option to cover it.
Adipose Tissue ; Ankle* ; Arteries ; Contracture ; Female ; Foot* ; Humans ; Male ; Skin ; Tibia ; Tissue Donors ; Transplants ; Wounds and Injuries

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Digital Artery Perforator Flaps.

Kwang Seog KIM

Archives of Reconstructive Microsurgery.2015;24(2):50-55. doi:10.15596/ARMS.2015.24.2.50

In the hand, few vessels can be classified as 'perforators'. Even today, the debate continues on whether or not branches of the digital artery should be considered as perforators. However, 'perforator' and 'perforator flaps' have become extremely popular within the microsurgery literature, and as such, the terminology has found widespread adoption across the hand surgery field. The finger is the most important sensory organ for tactile stimulation. The glabrous skin can be distinguished between the fingertip and the proximal tissue, with the fingertip having a higher functional and, therefore, reconstructive priority. Thus, sacrifice of the proximal glabrous skin can be justified in the reconstruction of fingertip defects. In this paper, the author reviews two flaps, 'lateral digital artery perforator flap' and 'volar digital artery perforator flap', both of which uses short branches of the digital artery as a vascular pedicle and are useful in fingertip construction.
Arteries* ; Fingers ; Hand ; Microsurgery ; Perforator Flap* ; Reconstructive Surgical Procedures ; Skin

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Updated Surgical Techniques and Expanded Indications of Free Vascularized Fibular Graft.

Jong Woong PARK

Archives of Reconstructive Microsurgery.2015;24(2):41-49. doi:10.15596/ARMS.2015.24.2.41

Free or pedicled vascularized fibular grafts (VFG) are useful for the reconstruction of large skeletal defects, particularly in cases of scarred or avascular beds, or in patients with combined bone and soft tissue defects. Compared to non-VFG, VEG, which contains living osteocytes and osteoblasts, maintains its own viability and serves as good osteoconductive and osteoinductive graft. Due to its many structural and biological advantages, the free fibular osteo- or osteocutaneous graft is considered the most suitable autograft for the reconstruction of long bone defects in the injured extremity. The traditional indication of VFG is the long bone and soft tissue defect, which cannot be reconstructed using a conventional operative method. Recently, the indications have been widely expanded not only for defects of midtibia, humerus, forearm, distal femur, and proximal tibia, but also for the arthrodesis of shoulder and knee joints. Because of its potential to allow further bone growth, free fibular epiphyseal transfer can be used for the hip or for distal radius defects caused by the radical resection of a tumor. The basic anatomy and surgical techniques for harvesting the VFG are well known; however, the condition of the recipient site is different in each case. Therefore, careful preoperative surgical planning should be customized in every patient. In this review, recently expanded surgical indications of VFG and surgical tips based on the author's experiences in the issues of fixation method, one or two staged reconstruction, size mismatching, overcoming the stress fracture, and arthrodesis of shoulder and knee joint using VFG are discussed with the review of literature.
Arthrodesis ; Autografts ; Bone Development ; Cicatrix ; Extremities ; Femur ; Forearm ; Fractures, Stress ; Hip ; Humans ; Humerus ; Knee Joint ; Osteoblasts ; Osteocytes ; Radius ; Shoulder ; Tibia ; Transplants*

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Anatomical Variation of the Lesser Saphenous Vein.

So Min HWANG ; Hao Ching PAN ; Hong Il KIM ; Yong Hui JUNG ; Hyung Do KIM

Archives of Reconstructive Microsurgery.2013;22(2):48-51.

PURPOSE: The lessor saphenous vein is an anatomical index in various surgical methods involving an approach to the popliteal fossa. However, occasionally, there have been some cases where the surgical process was difficult because the lessor saphenous vein was not found in the popliteal fossa during the operation process. The aim of this study is to determine the frequency of the anatomical variation of lessor saphenous vein not found in the popliteal fossa with a review of the literature. MATERIALS AND METHODS: This study was conducted on 83 cases of selective neurectomy for hypertrophic calf performed in our clinic from March 1997 to June 2013. There were 42 patients, with a mean age of 32.8 years old. We confirmed the existence of the lessor saphenous vein in the popliteal fossa during the operation process. RESULTS: Among 83 cases during this study period, the lesser saphenous vein was not found in four cases. In one patient, no lesser saphenous vein was found on either side of the popliteal fossa, and in two patients, no lesser saphenous vein was found on the left side of the popliteal fossa. As a result, the frequency of variation was found to be 4.8%. CONCLUSION: Due to the anatomical variation of the lessor saphenous vein, it may not be found in the midline of the popliteal fossa. Based on the literature review, several possibilities for failure to observe the lesser saphenous vein could be suggested. If surgeons are well aware of these possibilities, the steadier operation could be performed.
Anatomic Variation ; Humans ; Methods ; Popliteal Vein ; Saphenous Vein*

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Application of Lumbar Artery Perforator Flap for Reconstruction of Back Ulcer: Clinical Study with Computed Tomographic Angiography.

Jin Woo CHO ; Deok Woo KIM ; Deok Yeol KIM

Archives of Reconstructive Microsurgery.2013;22(2):43-47.

PURPOSE: Un-healing and centrally located defect on back area, it is sometimes a challenge for the reconstructive surgeon. Although skin grafts are considered as the first choice for reconstruction of large skin defect on the back region, it is not always helpful but vascularized flaps provide a superior functional and aesthetic outcome. The present study was designed to investigate the clinical anatomy of the lumbar artery perforator flap to reconstruct back ulcer. MATERIALS AND METHODS: Clinical anatomy study was undertaken using computed tomographic angiographic analysis. We identified the courses of lumbar arteries and its perforators, measured pedicle length by layers. The location of the perforator vessel was charted against anatomical landmarks. RESULTS: The pedicle lengths of the third and fourth lumbar artery perforator reached a mean of 27.8 mm and 37.1 mm respectively from superficial fascia to deep fascia. The fourth perforator was more laterally located than the third perforator and less than 1 cm above the iliac crest. A case in which the fourth lumbar artery perforator was used as flap pedicle is described. CONCLUSION: For the reconstruction of central defect on the back area, the lumbar artery perforator flap coverage may be a good alternative option. Computed tomographic angiography can easily identify the course and location of lumbar artery perforators and can be helpful to elevate the flap successfully.
Angiography* ; Arteries* ; Fascia ; Perforator Flap* ; Skin ; Subcutaneous Tissue ; Transplants ; Ulcer* ; Wound Closure Techniques

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Safety of a Single Venous Anastomosis in Anterolateral Thigh Free Flap for Extremity Reconstruction.

Sang Soo YU ; Hyun Woo SHIN ; Pil Dong CHO ; Soo Hyang LEE

Archives of Reconstructive Microsurgery.2015;24(1):1-6. doi:10.15596/ARMS.2015.24.1.1

PURPOSE: The main cause of flap loss in microsurgical tissue transfer is venous insufficiency. Whether or not multiple venous anastomoses prevents vascular thrombosis and reduces the risk of flap failure remains controversial. Some researchers are in favor of performing dual venous anastomoses, but the counterargument holds that performing a single venous anastomosis does provide advantages. MATERIALS AND METHODS: We carried out a retrospective analysis of 15 cases of anterolateral thigh free flap for extremity reconstruction performed between January 2011 and December 2013. The patients were categorized into two groups: group A that received a single venous anastomosis and group B that received dual venous anastomoses. The time of the anastomosis, size of the flap, complications of the flap, and survival rate of each group were analyzed. RESULTS: The total microsurgical time in the single venous anastomosis group ranged from 28 to 43 minutes (mean 35.9 minutes). The total time in the dual anastomoses group ranged from 50 to 64 minutes (mean 55.7 minutes). No statistically significant difference was found between the two groups with regards to postoperative complications and flap failure. CONCLUSION: Our study suggests that the use of a single venous anastomosis in the venous drainage of anterolateral thigh free flaps is a safe and feasible option for extremity reconstruction and provides shorter operative time and easy flap dissection.
Anastomosis, Surgical ; Drainage ; Extremities* ; Free Tissue Flaps* ; Humans ; Operative Time ; Postoperative Complications ; Reconstructive Surgical Procedures ; Retrospective Studies ; Survival Rate ; Thigh* ; Thrombosis ; Venous Insufficiency

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