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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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Extravasation Injury and Pressure Sore in Brain Damage Patient with Stiffness of the Limbs.

Kyu Hwa JUNG ; Hwan Jun CHOI ; Jun Hyuk KIM

Archives of Reconstructive Microsurgery.2014;23(1):36-39.

Extravasation injury refers to leakage of corrosive liquids from veins, resulting in tissue damage. The authors report on a case of extravasation injury to the left hand after administration of fluid to the antecubital area in a patient with brain damage. In order to minimize the effects of extravasation injury, rapid diagnosis and management are needed. In patients with stiffness, pressure sores can develop requiring more careful management by the medical staff.
Brain* ; Diagnosis ; Extravasation of Diagnostic and Therapeutic Materials ; Extremities* ; Hand ; Humans ; Medical Staff ; Persistent Vegetative State ; Pressure Ulcer* ; Vancomycin ; Veins

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Mondor's Disease Developed after Ultrasound-assisted Liposuction for Treatment of Axillary Bromhidrosis.

Hee Jong LEE ; Eun Key KIM

Archives of Reconstructive Microsurgery.2014;23(1):33-35.

Mondor's disease is an uncommon condition characterized by a palpable, cordshaped structure, which causes pain when pressed. Its known pathophysiology is thrombophlebitis of the superficial venous system. Although reported repeatedly, its definite cause is unknown and various possible causes have been identified, including surgery, irradiation, infection, malignancy, and trauma. We diagnosed this case to be Mondor's disease of the antecubital venous system, probably due to thermal injury of the proximal tributaries of the basilic or cephalic vein. Risk of thermal injury to the skin flap or the portal site remains a common complication, and as thermal injury to the blood vessel might also be considered, attention must be given when suctioning the area near a large superficial vessel.
Blood Vessels ; Lipectomy* ; Ocimum basilicum ; Phlebitis ; Skin ; Suction ; Thrombophlebitis ; Veins

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Ganglion of the Flexor Tendon Sheath between A1 Pulley and A2 Pulley.

Kyu Hwa JUNG ; Hwan Jun CHOI ; Jun Hyuk KIM

Archives of Reconstructive Microsurgery.2014;23(1):29-32.

Few articles have been written about the flexor tendon sheath ganglion in the finger, especially, between A1 pulley and A2 pulley. We report on rare cases of flexor tendon sheath ganglion with one symptomatic and two asymptomatic. All masses were evaluated using real-time ultrasonography and well-defined anechoic cystic lesions with posterior enhancement were observed. A 17-year-old female had a small mass at the 4th metacarpophalageal joint of her right hand, with pain and triggering. The patient underwent simple excision and a ganglion measuring 1.0x0.8 cm in size was derived from Camper's chiasm, between A1 pulley and A2 pulley. In two asymptomatic cases, ganglia measuring less than 0.5 cm in size observed. Based on our experience, real-time ultrasonography would be an excellent diagnostic modality in determining the treatment method in flexor tendon sheath ganglia, and surgical excision is recommended in symptomatic, especially triggering patients.
Adolescent ; Female ; Fingers ; Ganglia ; Ganglion Cysts* ; Hand ; Humans ; Joints ; Tendons* ; Ultrasonography

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Hatchet-type Gluteus Maximus Musculocutaneous Flap for Reconstruction of Sacral Pressure Sore.

Sang Wook BAE ; Tae Kang LIM ; Hyong Suk KIM ; Baek Yong SONG

Archives of Reconstructive Microsurgery.2014;23(1):25-28.

One of the most frequently used flaps for coverage of sacral skin and soft-tissue defects is the gluteus maximus musculocutaneous flap. These authors encountered two cases of sacral pressure sore, for which reconstructive surgery was performed, using the hatchet-shaped gluteus maximus musculocutaneous flap - a modified flap type. We report on our experience in treatment of these two cases, with an excellent outcome.
Myocutaneous Flap* ; Pressure Ulcer* ; Sacrum ; Skin

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Use of the Free Flap for Large Defect with Bronchopleural Fistula: Case Report.

Joo Seok PARK ; Se Hoon CHOI ; Eun Key KIM

Archives of Reconstructive Microsurgery.2014;23(1):21-24.

Bronchopleural fistula is an unnatural communication between the bronchial tree and pleural space. Closure of the bronchial stump using various muscular flaps has been previously reported. There have been few reports on treatment of large defects with bronchopleural fistula accompanied by surrounding muscle injury. We report on our experience with two patients suffering from large defect with bronchopleural fistula, who were treated with free flaps. No recurrence of bronchopleural fistula was observed during follow-up.
Bronchial Fistula ; Fistula* ; Follow-Up Studies ; Free Tissue Flaps* ; Humans ; Recurrence

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Free Flap Transplantation in Open Tibial Fracture with Vessel Injury in the Elderly.

Chang Eun YU ; Myung Jae YOO ; Jun Mo LEE

Archives of Reconstructive Microsurgery.2014;23(1):18-20.

Two aged patients who had open tibial fractures with arterial injury caused by high energy accidents underwent emergency arterial reconstruction using a greater saphenous vein and soft tissue repair using free flaps. In the patients, soft tissue necrosis developed and tibias were exposed at postoperative third week. Follow-up angiography through the superficial femoral artery showed occlusion of the anterior tibial artery. The anterior tibial artery was reconstructed using the contralateral greater saphenous vein graft and the latissimus dorsi myocutaneous and rectus abdominis muscle free flaps were transplanted for repair of necrotic soft tissue. The reconstructed arteries showed good perfusion to the new free flaps until union of the tibias occurred. The patients were followed-up for 21 years and 17 years postoperatively, respectively. In management of open comminuted fracture of the tibia, injury of the arterial system must be ruled out by angiography in addition to evaluation of the degree of soft tissue injury.
Aged* ; Angiography ; Arteries ; Emergencies ; Femoral Artery ; Follow-Up Studies ; Fractures, Comminuted ; Free Tissue Flaps* ; Humans ; Necrosis ; Perfusion ; Rectus Abdominis ; Saphenous Vein ; Soft Tissue Injuries ; Superficial Back Muscles ; Tibia ; Tibial Arteries ; Tibial Fractures* ; Transplants

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Lateral Supramalleolar Flap for Reconstruction of Soft Tissue Defect around the Ankle Joint.

Soo Hong HAN ; Seong Hui KIM ; Soon Chul LEE ; Ho Jae LEE ; Woo Hyun KIM ; Sun Tae BONG ; Won Tae SONG

Archives of Reconstructive Microsurgery.2014;23(1):13-17.

PURPOSE: Soft tissue defect on foot and ankle is vulnerable and requires a thin flap for improvement of aesthetic and functional results. Lateral supramalleolar flap is a simple and fast procedure, which can preserve and supply reliable constant blood flow, and causes fewer donor site complications. The authors reviewed our cases and report the clinical results. MATERIALS AND METHODS: Ten cases of soft tissue defects on the lower leg, around the ankle were treated with lateral supramalleolar flap. There were seven males and three females with a mean age of 54.8 years. The mean size of flaps was 5.9x6.3 cm and the mean follow-up period was 23 months. Flap survival and postoperative complications were evaluated. RESULTS: Nine flaps survived completely without loss of flap. There was one case of partial wound dehiscence requiring debridement and repair, and another case of necrotic flap change requiring partial bone resection and closure. All patients were capable of weight bearing ambulation at the last follow up. CONCLUSION: The authors suggest that the lateral supramalleolar flap could be a useful option for treatment of soft tissue defect around the ankle joint.
Ankle ; Ankle Joint* ; Debridement ; Female ; Follow-Up Studies ; Foot ; Humans ; Leg ; Male ; Postoperative Complications ; Tissue Donors ; Walking ; Weight-Bearing ; Wounds and Injuries

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Aesthetic Considerations after Free Flap Reconstruction.

Sang Shin LEE ; Eun Key KIM

Archives of Reconstructive Microsurgery.2014;23(1):8-12.

PURPOSE: The success rate of free flap operation has shown a recent increase. Especially for breast reconstructive patients, aesthetic results are considered a necessity. However, for patients who underwent reconstruction in parts of the body other than breast, for example, head and neck, lower and upper extremities, aesthetic considerations are underscored. Nowadays, however, aesthetic standpoint toward these patients is changing. MATERIALS AND METHODS: We conducted a retrospective review of 8 patients who underwent secondary procedures after free flap surgery from March of 2011 to April of 2014. RESULTS: Secondary refinement was a safe and less time-consuming technique for maximizing the function and aesthetic appearance for the patient. CONCLUSION: Appearance has become increasingly important with regard to function and quality of life. Therefore, for free flap reconstructive patients, secondary refinements may be considered in order to change the shape and contour. The secondary refinements are critical to the final result and must be a planned part of the entire reconstructive sequence.
Breast ; Free Tissue Flaps* ; Head ; Humans ; Neck ; Quality of Life ; Retrospective Studies ; Upper Extremity

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Risk and Effectiveness of Using Thrombin in Microvascular Free Tissue Transfer.

Sae Hwi KI ; Han Joon KIM

Archives of Reconstructive Microsurgery.2014;23(1):1-7.

PURPOSE: Recent studies have reported on application of fibrin glue composed of fibrinogen and thrombin to nerve anastomosis, which can be another candidate for vessel anastomosis. However, no research regarding the risk and effectiveness of thrombin in microvascular free tissue transfer has been reported. Therefore, the aim of study is to determine the risk and effectiveness of thrombin on microvascular free tissue transfer through clinical cases. MATERIALS AND METHODS: Twenty-five patients underwent free flap reconstruction for soft tissue defect or bone exposure in our institute from March 2011 to February 2014. In the group using thrombin, dissolved powder thrombin (5,000 IU/amp) was mixed with 10 mL normal saline. Saline mixed with thrombin was applied on the flap, recipient, and around vessel anastomosis. In the control group, free flap was performed using the same method, except using thrombin. We analyzed the results between the two groups. RESULTS: All flaps survived. The group using thrombin included 14 patients and the control group included 11 patients. Hematoma was found in two cases, respectively, in each group. The group using thrombin showed lower incidence of hematoma than the control group. No difference in survival rate of the flap was observed between the thrombin group and the control group. CONCLUSION: Results of this study showed that use of saline mixed with thrombin in free tissue transfer may be safe and effective for prevention of hematoma formation in the recipient site.
Fibrin Tissue Adhesive ; Fibrinogen ; Free Tissue Flaps ; Hematoma ; Humans ; Incidence ; Survival Rate ; Thrombin*

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