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A Case of Malignant Peripheral Nerve Sheath Tumor with Neurofibromatosis Type 1.

Sang Kyu CHOI ; Cheol Keun KIM ; Soon Heum KIM ; Dong In JO

Archives of Reconstructive Microsurgery.2017;26(1):23-25. doi:10.15596/ARMS.2017.26.1.23

The malignant peripheral nerve sheath tumor (MPNST) originates from neurofibromatosis type 1 (NF1). Because NF1 patients have many accompaniments with growth of additional masses, they usually overlook potential malignant changes in their masses. Our patient had two growing mass near the left elbow for several months; however, she ignored these masses until 7 days prior to writing this article, at which time they began bleeding. Traditionally, sarcoma including MPNST treatment consisted of amputation of the involved extremity. However, treatment now consists of surgical resection with adjuvant therapy. Therefore, we conducted resection of the mass and subsequent coverage with a local advancement flap. We believe that the most effective treatment for MPNST is early diagnosis and fast surgery, coupled with notification that there is always potential for malignant change in NF1 patient's masses.
Amputation ; Diagnosis ; Drug Therapy ; Early Diagnosis ; Elbow ; Extremities ; Hemorrhage ; Humans ; Neurilemmoma ; Neurofibromatoses* ; Neurofibromatosis 1* ; Peripheral Nerves* ; Sarcoma ; Writing

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Bowel Perforation Due to Immobilization after Resurfacing Thumb with Anterolateral Thigh Free Flap in an Elderly Diabetic Woman.

Seong Hoon PARK ; Joo Hyun KIM ; In Suck SUH ; Kwang Yong KIM ; Hii Sun JEONG

Archives of Reconstructive Microsurgery.2017;26(1):18-22. doi:10.15596/ARMS.2017.26.1.18

Inevitable immobilization after surgery on lower extremities can induce chronic constipation. Elderly diabetic women usually express ambiguous gastrointestinal symptoms and signs. We present here a case of panperitonitis developed from severe fecal impaction in an elderly diabetic woman after hand reconstruction using material harvested from the lower extremities. A 68-year-old diabetic female underwent anterolateral thigh free flap and wound revision twice on the left thumb. Three weeks after surgery, she complained about mild abdominal pain though she had daily defecation. Despite encouraging ambulation, her compliance was low. Resection of the sigmoid colon and colostomy were performed after diagnosis with bowel perforation. However, the patient went into septic shock and died with multiorgan failure after the guardians issued a DNR (do not resuscitate) order. For preventing bowel perforation, increased uptake of dietary fiber and early ambulation postoperatively should be encouraged, after even hand surgeries.
Abdominal Pain ; Aged* ; Colon, Sigmoid ; Colostomy ; Compliance ; Constipation ; Defecation ; Diabetes Complications ; Diagnosis ; Dietary Fiber ; Disabled Persons ; Early Ambulation ; Fecal Impaction ; Female ; Free Tissue Flaps* ; Hand ; Humans ; Immobilization* ; Lower Extremity ; Shock, Septic ; Thigh* ; Thumb* ; Walking ; Wounds and Injuries

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Dual Perforator Flap for Reconstruction of Large Sacral Defects: Superior Gluteal Artery Perforator Super-Flap with Parasacral Perforator.

Sang Pil TAE ; Seong Yoon LIM ; Jin Kyung SONG ; Hong Sil JOO

Archives of Reconstructive Microsurgery.2017;26(1):14-17. doi:10.15596/ARMS.2017.26.1.14

The superior gluteal artery perforator flap technique has increasingly been used for soft tissue defects in the sacral area following its introduction nearly 25 years ago. Advantages in covering sacral defects include muscle sparing, versatility in design, and low donor side morbidity. The bilateral superior gluteal artery perforator flap procedure is planned in cases of large sacral defects that cannot be covered with the unilateral superior gluteal artery perforator flap. Here, we report two cases of large sacral defects in which patient factors of poor general health, such as old age, pneumonia, and previous operation scar, led to use of a large unilateral superior gluteal artery perforator super-flap with parasacral perforator. The approach was utilized to reduce the operation time and prevent unpredictable flap failure due to the large flap size. Even though the parasacral perforator was included, the versatility of the large superior gluteal artery perforator flap was preserved because sufficient perforator length was acquired after adequate dissection.
Arteries* ; Cicatrix ; Humans ; Perforator Flap* ; Pneumonia ; Tissue Donors

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Usefulness of Microscopic Procedures in Composite Grafts for Fingertip Injuries.

Dong In JO ; Yu Kwan SONG ; Cheol Keun KIM ; Jin Young KIM ; Soon Heum KIM

Archives of Reconstructive Microsurgery.2017;26(1):9-13. doi:10.15596/ARMS.2017.26.1.9

PURPOSE: Fingertip amputations are the most common type of upper limb amputations. Composite grafting is a simple and cost-effective technique. Although many factors have investigated the success of composite grafting, the success rate is not high. Therefore, this study was conducted to investigate whether the microscopic procedure process during composite grafts improves the success rate. MATERIALS AND METHODS: Thirteen cases of unreplantable fingertip amputation underwent a microscopic resection procedure for composite graft in the operating room. The principle of the procedure was to remove the least devitalized tissue, maximize the clean tissue preservation and exact trimming of the acral vessel and to remove as many foreign bodies as possible. RESULTS: All fingertips in the thirteen patients survived completely without additional procedures. CONCLUSION: Composite grafting allows for the preservation of length while avoiding the donor site morbidity of locoregional flaps. Most composite grafts are performed as quickly as possible in a gross environment. However, we take noticed the microscopic resection. This process is thought to increase the survival rate for the following reasons. First, the minimal resection will maximize the junction surface area and increase serum imbibition. Second, sophisticated trimming of injured distal vessels will increase the likelihood of inosculation. Third, accurate foreign body removal will reduce the probability of infection and make it possible to increase the concentration and efficiency in a microscopic environment. Although there is a need for more research into the mechanisms, we recommend using a composite graft under the microscopic environment.
Amputation ; Finger Injuries ; Foreign Bodies ; Humans ; Operating Rooms ; Survival Rate ; Tissue Donors ; Tissue Preservation ; Transplants* ; Upper Extremity

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Management of Lymphedema.

Jaehoon CHOI ; Seongwon LEE ; Daegu SON

Archives of Reconstructive Microsurgery.2017;26(1):1-8. doi:10.15596/ARMS.2017.26.1.1

Lymphedema is a frequent complication after the treatment of various cancers, particularly breast cancer, gynecological cancers, melanomas, and other skin and urological cancers. Lymphedema patients have chronic swelling of the affected extremity, recurrent infections, limited mobility and decreased quality of life. Once lymphedema develops, it is usually progressive. Over time, lymphedema leads to fat deposition and subsequent fibrosis of the surrounding tissues. However, there is no cure for lymphedema. Recently, the development of microsurgery has led to introduction of new surgical techniques for lymphedema, such as vascularized lymph node transfer. We report here the latest trends in the surgical treatment of lymphedema, as well as diagnosis and conventional treatments of lymphedema.
Anastomosis, Surgical ; Breast Neoplasms ; Diagnosis ; Extremities ; Fibrosis ; Humans ; Lymph Nodes ; Lymphedema* ; Melanoma ; Microsurgery ; Quality of Life ; Skin ; Urologic Neoplasms

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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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