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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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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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Pedicled Anterolateral Thigh Flaps for Reconstruction of Recurrent Trochanteric Pressure Ulcer.

Sujin BAHK ; Seung Chul RHEE ; Sang Hun CHO ; Su Rak EO

Archives of Reconstructive Microsurgery.2015;24(1):32-36. doi:10.15596/ARMS.2015.24.1.32

The reconstruction of recurrent pressure sores is challenging due to a limited set of treatment options and a high risk of flap loss. Successful treatment requires scrupulous surgical planning and a multidisciplinary approach. Although the tensor fascia lata flap is regarded as the standard treatment of choice-it provides sufficient tissue bulk for a deep trochanteric sore defect-plastic surgeons must always consider the potential of recurrence and accordingly save the second-best tissues. With the various applications of anterolateral thigh (ALT) flaps in the reconstructive field, we report two cases wherein an alternative technique was applied, whereby pedicled ALT fasciocutaneous island flaps were used to cover recurrent trochanteric pressure sores. The postoperative course was uneventful without any complications. The flap provided a sound aesthetic result without causing a dog-ear formation or damaging the lower-leg contour. This flap was used as an alternative to myocutaneous flaps, as it can cover a large trochanteric defect, recurrence is minimized, and the local musculature and lower-leg contour are preserved.
Fascia Lata ; Femur* ; Myocutaneous Flap ; Perforator Flap ; Pressure Ulcer* ; Recurrence ; Surgical Flaps ; Thigh*

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Preserved Respiratory Function after Reconstruction of a Large Chest Wall Defect.

Yu Jin KIM ; Yoon Ji KIM ; Jae Ik LEE

Archives of Reconstructive Microsurgery.2015;24(1):28-31. doi:10.15596/ARMS.2015.24.1.28

A case report of a patient who developed radiation-induced sarcoma in the left chest wall is presented. The patient had partial mastectomy and adjuvant radiation therapy (total dose, 5,220 cGy) and chemotherapy. Five years later, she visited with rapidly growing mass with central ulceration in the irradiated chest wall. The mass was diagnosed as malignant fibrous histiocytoma. The chest wall mass resected en bloc (23x18 cm) including five consecutive ribs. After the defected thoracic cage was reinforced using a polytetrafluoroethylene patch, omental flap and split thickness skin graft was done for soft tissue coverage. We applied negative pressure wound closer system for effective suction of omeantal exudate. The wound healed without complications. The patient suffered no perioperative pulmonary complications. Pulmonary function tests showed no significant changes. Each of Gore-Tex, omental flap, negative pressure wound therapy and skin graft is widely used method. However, If these methods are used in combination, we can reconstruct the large defect of chest wall including multiple ribs without any repiratory function problems.
Drug Therapy ; Exudates and Transudates ; Histiocytoma, Malignant Fibrous ; Humans ; Mastectomy, Segmental ; Negative-Pressure Wound Therapy ; Omentum ; Polytetrafluoroethylene ; Respiratory Function Tests ; Ribs ; Sarcoma ; Skin ; Suction ; Thoracic Wall* ; Transplants ; Ulcer ; Wounds and Injuries

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Perforator Reconstruction to Salvage the Jeopardized Flaps.

Jin Sup EOM ; Dong Hoon CHOI

Archives of Reconstructive Microsurgery.2015;24(1):24-27. doi:10.15596/ARMS.2015.24.1.24

During flap elevation, most perforators are cut except one or more perforators that are essential to flap survival. However these cutout perforators can cause deterioration of the blood circulation of the flap. To salvage the jeopardized flaps, rebuilding the perforator system is essential for flap survival. In the first case, after flap elevation, the upper abdominal flap margin was severely ischemic. To supply blood to the upper abdominal flaps, we found and used a major perforator underneath the upper abdominal flap which was cut earlier during the elevation, and we performed reanastomosis with ipsilateral deep inferior epigastric artery. Upper abdominal flap ischemic area was limited to a narrow suture area. In the second case, we performed free superficial inferior epigastric artery (SIEA) flap reconstruction. After successful anastomosis of the SIEA and superficial inferior epigastric vein (SIEV) with internal mammary artery and vein, serious venous congestion occurred immediately because of SIEV malfunction. We found the largest perforator vein under the flap, as an alternate way to drain, then connected it with the thoracoacromial vein with a vein graft harvested in the contralateral SIEV. Circulation has improved. In conclusion, perforator system reconstruction is essential in a jeopardized flap salvage.
Blood Circulation ; Epigastric Arteries ; Female ; Free Tissue Flaps ; Hyperemia ; Mammaplasty ; Mammary Arteries ; Perforator Flap ; Sutures ; Transplants ; Veins

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Vascular Remodeling with a Microvascular Anastomotic Coupler System: A Case Report.

Changbae HONG ; Hyeonjung YEO ; Daegu SON

Archives of Reconstructive Microsurgery.2015;24(1):20-23. doi:10.15596/ARMS.2015.24.1.20

Despite increased utilization of microvascular anastomotic coupler (MAC) devices, the consequences have yet to be fully explored in terms of vascular regeneration. Removal of an exposed venous coupler is described herein, documenting normal circulatory flow through the remodeled site of application. A 25-year-old man who underwent open reduction and rigid fixation elsewhere for traumatic calcaneal fracture ultimately presented with a necrotic postoperative wound. The debrided defect was treated by free thigh perforator flap, incorporating a MAC device. Three months later, the flap remained viable, but the MAC itself was exposed. Structural integrity of the vessel and blood flow were sustained as the device was carefully removed, confirming true vascular remodeling in this example of MAC usage.
Adult ; Humans ; Perforator Flap ; Regeneration ; Thigh ; Wounds and Injuries

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Penile Reconstruction after Extensive Excision of Sclerosing Lipogranuloma: How to Make the Shape of Scrotum, Penile Shaft and Suprapubic Region with a Rectangular Radial Forearm Free Flap.

Tae Gon KIM ; Su Won HUR ; Yong Ha KIM ; Jun Ho LEE ; Ki Hak MUN

Archives of Reconstructive Microsurgery.2015;24(1):16-19. doi:10.15596/ARMS.2015.24.1.16

The authors had five cases of penoplasty from more than half of the scrotum to the suprapubic region using a fasciocutaneous radial forearm free flap (RFFF) after extensive excision of sclerosing lipogranuloma. Although the harvested RFFF was a rectangular shape, the authors made the shape of scrotum, penile shaft, and suprapubic region by using well designed geometry and several quilting sutures on junction of scrotum and penis. The contour of scrotum and penis was well maintained, and there were no complications, such as scrotal contracture, penile deformity, and erectile dysfunction during the one year follow up period in all five cases. There were no recurrent lesions and no need for further surgery.
Congenital Abnormalities ; Contracture ; Erectile Dysfunction ; Follow-Up Studies ; Forearm* ; Foreign-Body Reaction ; Free Tissue Flaps* ; Granuloma ; Male ; Penis ; Scrotum* ; Sutures

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Comparative Study of Electromyography and Hand Elevation Test in Carpal Tunnel Syndrome.

Tae Kyoung YUN ; Deok Yeol KIM ; Duck Sun AHN

Archives of Reconstructive Microsurgery.2015;24(1):13-15. doi:10.15596/ARMS.2015.24.1.13

PURPOSE: Since the hand elevation test was first introduced by Ahn in 2001, it has been one of most performing provocative test for diagnosing carpal tunnel syndrome. Although many studies have been published on the hand elevation test, there are no study that can explain why false-negative results of hand elevation test appears in carpal tunnel syndrome patients diagnosed by electromyography (EMG) findings. Therefore we searched out whether hand elevation test is related with EMG severity. MATERIALS AND METHODS: We made a retrospective study of 654 bilateral carpal tunnel syndrome patients. Among them 134 were studied which had different hand elevation test results on each hands. The paired samples t-test was used to compare the EMG severity of each group. The relationships between hand elevation test and EMG severity were examined using Pearson-product correlations. Comparing whether the frequency of false negative hand elevation were different between both hands, and whether the severity of EMG depends on which side of hand is, was evaluated with Mann-Whitney U-test. RESULTS: Severity of EMG in positive group was moderate to severe on average, whereas mild to moderate on negative group, with significant difference statistically (p<0.001). Correlation between the hand elevation test results and EMG severity also showed significance statistically (p<0.001). CONCLUSION: Mild severity of EMG was found out to be the factor affecting the false results. However, EMG severity and hand elevation test shows a meaningful correlation, supporting the value of hand elevation test.
Carpal Tunnel Syndrome* ; Electromyography* ; Hand* ; Humans ; Retrospective Studies

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Long-Term Outcome of Free Rectus Abdominis Musculocutaneous Flap for General Soft-Tissue Reconstruction.

Jungheum PARK ; Daegu SON ; Joongwon SONG

Archives of Reconstructive Microsurgery.2015;24(1):7-12. doi:10.15596/ARMS.2015.24.1.7

PURPOSE: The rectus abdominis musculocutaneous (RAM) flap has contributed to the efficient reconstruction of soft tissue defects. The flap has the advantage of easy dissection, minimal donor site morbidity, and the constant vascular anatomy with long pedicle. Authors used the free RAM flap to reconstruct multi-located soft tissue defects while still considering functionality and aesthetics. We present the long-term outcomes and versatility of free RAM flaps. MATERIALS AND METHODS: From 1994 to 2004, all patients who underwent soft tissue reconstruction with free RAM flap were reviewed retrospectively. The site of the reconstruction, vessels of anastomosis, type of RAM flap, and outcomes, including flap success rate, hospital stay after flap transfer, conduction of secondary procedure, flap complications, and donor-site complications were analyzed. RESULTS: Twenty-one patients underwent 24 free RAM flaps in site of breast, face, upper extremity and lower extremity. Mean follow-up period was 36.1 months (range, 3~156 months). The overall success rate was 92% with only a loss of 2 flaps. Minor complications related to transferred flaps were necrosis of 2 partial flaps, hematoma formation in 3 cases, and a wound infection in 1 case. Donor site morbidity was not observed. Debulking surgery was performed in 4 patients, and scar revision was performed in 3 patients. CONCLUSION: Free RAM flap is a workhorse flap for general soft-tissue reconstruction with minimal donor site morbidity with aesthetically good results. Thus, the free RAM flaps are versatile, and sturdy for any sites of soft-tissue where reconstruction could be performed.
Breast ; Cicatrix ; Esthetics ; Follow-Up Studies ; Free Tissue Flaps ; Hematoma ; Humans ; Length of Stay ; Lower Extremity ; Myocutaneous Flap* ; Necrosis ; Reconstructive Surgical Procedures ; Rectus Abdominis* ; Retrospective Studies ; Tissue Donors ; Treatment Outcome ; Upper Extremity ; Wound Infection

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Reconstruction of Lower Face with Submental Artery Perforator Flap.

Jung Kook SONG ; Jae Kyoung KANG ; Myoung Soo SHINN ; Byung Min YUN

Archives of Reconstructive Microsurgery.2014;23(1):40-43.

A submental artery perforator flap was applied to the defect site after surgical excision of basal cell carcinoma on the right lower face. Three points were beneficial: it was perfect for assuring the safe margin of the mandibular branch of the facial nerve as well as intact platysma muscle, functionally; harvesting the flap was much easier than that of submental artery flap, surgically; and the color and contour were well matched aesthetically.
Arteries* ; Carcinoma, Basal Cell ; Facial Nerve ; Perforator Flap*

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