• Archives of Plastic Surgery
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• v.49 no.1
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• pp.61-69
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• 2022

Background Single free flaps are a commonly used reconstructive method for multiple soft tissue defects in digits. We analyzed the flap size, division timing, and degree of necrosis in cases with various types of flap division. Methods We conducted a retrospective review of the medical charts of patients who had undergone single free flap reconstruction for multiple soft tissue defects across their digits from 2011 to 2020. The flap types included were the lateral arm free flap, venous forearm free flap, thenar free flap, hypothenar free flap, anterolateral thigh free flap, medial plantar free flap, and second toe pulp free flap. Flap size, anastomosed vessels, division timing, and occurrence of flap necrosis were retrospectively investigated and then analyzed using the t-test. Results In total, 75 patients were included in the analysis. The success rate of the free flaps was 97.3%. All flaps were successfully divided after at least 17 days, with a mean of 47.17 days (range, 17-243 days) for large flaps and 42.81 days (range, 20-130 days) for the medium and small flaps (P=0.596). The mean area of flap necrosis was 2.38% in the large flaps and 2.58% in the medium and small flaps (P=0.935). Severe necrosis of the divided flap developed in two patients who had undergone flap division at week 6 and week 34. Conclusions In cases where blood flow to the flap has been stable for more than 3 weeks, flap division can be safely attempted regardless of the flap size.

• The Journal of the Korean dental association
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• v.48 no.8
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• pp.607-614
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• 2010

Reconstruction after ablative oral cancer surgery is challenging mission. Soft tissue and hard tissue could be resected in case of advanced oral cancer. The final goal of oral reconstruction is to gain normal swallowing, chewing and speech. Nowadays, free flap reconstruction after oral cancer resection is more popular than pedicled flap. Microsurgical reconstruction with free flap could be used effectively in complicated cases of oral cavity defect. However, complications could be happened. So not only meticulous preoperative study about the extent of defects but also the donor site dressing after surgery were performed to prevent postoperative complication. The most favorite free flap for soft tissue reconstruction is radial forearm flap. It has a lot of advantages such as pliable, hairless, reliable vessels, appropriate diameter of radial artery and diverse flap design. And the most popular free flap for jaw reconstruction is free fibular flap. In this article, we report the classification of flap for reconstruction and reveal the pits and falls of radial forearm free flap and free fibular flap.

• Journal of Trauma and Injury
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• v.23 no.2
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• pp.157-162
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• 2010

Purpose: Free flap reconstruction in the pediatric population is difficult. However, microsurgery has had remarkable success rates in children. The aim of study is to present our clinical experience using free flap for reconstruction of soft tissue defects in children and to describe long-term follow-up results. Methods: Between June 2002 and July 2010, 30 cases of pediatric reconstruction were performed with free flap. The authors analyzed several items, such as the kind of flap, associated complications, and growth problems. Results: Among the 30 cases, 21 cases were due to traffic accidents, 5 to cancer, and 4 to falls and other soft tissue defects. The lower leg and foot were the most common sites of the lesion. In the free flap operations we have done, 20 cases involved an anterolateral thigh perforator free flap, 6 a superficial circumflex iliac perforator free flap, and 4 an upper medial thigh perforator free flap. In early postoperative complications, partial necrosis was seen in 2 cases, infection in 1 case, and the hematoma in 1 case. A satisfactory success rate and functional results were achieved. Conclusion: Free flap reconstruction in children allows satisfactory function with no significant effect on growth. Free flaps are regarded as the primary choice for selective pediatric reconstructive cases.

• Archives of Plastic Surgery
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• v.41 no.2
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• pp.148-152
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• 2014

Background Free flap surgery for head and neck defects has gained popularity as an advanced microvascular surgical technique. The aims of this study are first, to determine whether the known risk factors such as comorbidity, tobacco use, obesity, and radiation increase the complications of a free flap transfer, and second, to identify the incidence of complications in a radial forearm free flap and an anterolateral thigh perforator flap. Methods We reviewed the medical records of patients with head and neck cancer who underwent reconstruction with free flap between May 1994 and May 2012 at our department of plastic and reconstructive surgery. Results The patients included 36 men and 6 women, with a mean age of 59.38 years. The most common primary tumor site was the tongue (38%). The most commonly used free flap was the radial forearm free flap (57%), followed by the anterolateral thigh perforator free flap (22%). There was no occurrence of free flap failure. In this study, risk factors of the patients did not increase the occurrence of complications. In addition, no statistically significant differences in complications were observed between the radial forearm free flap and anterolateral thigh perforator free flap. Conclusions We could conclude that the risk factors of the patient did not increase the complications of a free flap transfer. Therefore, the risk factors of patients are no longer a negative factor for a free flap transfer.

• Archives of Craniofacial Surgery
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• v.16 no.3
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• pp.105-113
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• 2015

The main challenge in pharyngoesophageal reconstruction is the restoration of swallow and speech functions. The aim of this paper is to review the reconstructive options and associated complications for patients with head and neck cancer. A literature review was performed for pharynoesophagus reconstruction after ablative surgery of head and neck cancer for studies published between January 1980 to July 2015 and listed in the PubMed database. Search queries were made using a combination of 'esophagus' and 'free flap', 'microsurgical', or 'free tissue transfer'. The search query resulted in 123 studies, of which 33 studies were full text publications that met inclusion criteria. Further review into the reference of these 33 studies resulted in 15 additional studies to be included. The pharyngoesophagus reconstruction should be individualized for each patient and clinical context. Fasciocutaneous free flap and pedicled flap are effective for partial phayngoesophageal defect. Fasciocutaneous free flap and jejunal free flap are effective for circumferential defect. Pedicled flaps remain a safe option in the context of high surgical risk patients, presence of fistula. Among free flaps, anterolateral thigh free flap and jejunal free flap were associated with superior outcomes, when compared with radial forearm free flap. Speech function is reported to be better for the fasciocutaneous free flap than for the jejunal free flap.

• Archives of Plastic Surgery
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• v.42 no.5
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• pp.608-613
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• 2015

Background The purpose of this study was to compare postoperative morbidities and functional outcomes of pectoralis major myocutaneous (PMMC) flap and cutaneous free flap reconstruction approaches in hypopharyngeal squamous cell carcinoma patients. Methods We retrospectively reviewed records from 99 patients who underwent hypopharyngeal reconstruction with a cutaneous free flap (n=85) or PMMC flap (n=14) between 1995 and 2013. Morbidity was classified into hospitalization, medical, or flap-related complications. Functional outcomes were classified into oral re-alimentation and decannulation time. Results The overall flap-related complication rate was higher in the PMMC flap group (n=8, 57.1%; P=0.019), but the medical morbidity rate was higher in the cutaneous free flap group (n=68, 80%; P=0.006). The rate of pneumonia was higher in the cutaneous free flap group (n=48, 56.5%; P=0.020). Pulmonary premorbidity was the variable most significantly associated with pneumonia (odds ratio=3.012, P=0.012). There was no statistically significant difference in oral re-alimentation and decannulation time between the two groups. Conclusions Although the functional superiority of free flaps has been reported in many studies, our results do not support this hypothesis. One limitation of our study is the relatively smaller flap size and fewer PMMC flap cases compared with the cutaneous free flap group. The low postoperative medical morbidity incidence rate in the PMMC flap group was clinically significant; however, the free flap group had more flap-related complications. Thus, PMMC flaps should be considered a viable option, especially for patients with pulmonary premorbidities.

• Archives of Reconstructive Microsurgery
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• v.6 no.1
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• pp.87-95
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• 1997

Traumatic injury to the hand often leads to soft tissue defects with exposed tendons, bones, or joints. Though many new flap have been introduced, the choice of flap that would be best for the patient depends on such factors as the site, size, and degree of wounds. Additionally the selected surgical method should be yielded cosmetic and functional superiority by the one-staged reconstruction. In our experience, small to medium sized soft tissue defect with bone and tendon exposure of hand can be resurfaced with an arterialized venous free flap from the volar aspect of distal forearm. Wide and deep defects of the hand can be covered with a sensory cutaneous free flap such as the medial plantar free flap, dorsalis pedis free flap, and radial forearm free flap. Specialized flap such as wrap-around flap, toe-to-finger transfer, onychocutaneous free flap can be used for the recontruction of defect on the thumb and finger. Based on the above considerations and our clinical experience of 60 free flap cases of the hand, the various methods for the proper repair of soft tissue defects of the hand are described. And we obtained satisfactory functional and cosmetic results with 95% success rate of free flap.

• Archives of Reconstructive Microsurgery
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• v.8 no.1
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• pp.35-43
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• 1999

There are lots of reconstructive ways like direct closure, skin graft, local flap, regional flap, distant flap, free flap and so on. Microsurgical reconstruction is regarded as the last step in various reconstructive methods. So the failure of this last step causes the troublesome situation for both of patients and surgeon. The purpose of this paper is to investigate the problems in failed free flap surgery and to introduce the strategy of appropriate management in wound of free flap failure. We performed 252 cases of free flap surgeries from May, 1988 to June, 1998. Among these cases, we failed 9 cases of free flaps. Patients' age ranged from 19 to 63. There were 7 males and 2 females. Site of failure were 3 head and neck areas, 2 hands, and 4 lower extremities. However there was no failure in breast, trunk, buttock, and genitalia. 7 patients who had region of head and neck, and lower extremity underwent the second free flap surgery successfully in postoperative 4 to 16 days following debridement of necrotic tissue. However 2 patients who had region in hand were managed with conventional treatment like skin graft and distant flap. Vein grafts were needed in 3 cases of 7 second free flaps, and 1 patients needed sequentially-linked free flaps with two flaps. The second free flaps were inevitable for head and neck area because the large complex wound may cause the lifethreatening condition without immediate coverage with well vascularized flap. Lower extremity also needed second free flap for limb salvage. Hand could be managed with conventional method, even though healing time was quite delayed. We thought second free flap surgery in free flap failure cases should be performed with more careful preoperative evaluation and refined surgery. Success of second free flap surgery could recover the very difficult situation due to previously failed operation.

• Archives of Reconstructive Microsurgery
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• v.16 no.1
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• pp.39-47
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• 2007

With the advent of microsurgery, perforator free flap is nowadays considered the first choice for reconstruction of the extensive defect of the extremities because of their moderate thickness. Among them, anterior (anterolateral and anteromedial) thigh perforator free flaps provide the first choice for reconstruction of various soft tissue defects of the extremities with many advantage such as its large, uniform thickness, long vascular pedicle with proper vessel size and minimal donor site morbidity. But, it has still some criticism of unreliable perforators which makes us very careful in elevating the flap. Between March of 2006 and February of 2007, we treated 7 patients of soft tissue defects in the hand and lower extremities with anterior thigh perforator free flap at Hallym and DongGuk University Hospital. We performed 6 anterolateral thigh perforator free flaps based on the descending branch of lateral circumflex femoral artery (LCFA) and 1 anteromedial thigh perforator free flap based on the innominate branch of the LCFA. While approaching for the anterolateral thigh free flap, we happen to meet the cases which we should change into the anteromedial thigh free flap uneventfully on the operating field. In contrast to the original design of anterolateral thigh free flap, we had to harvest the anteromedial thigh perforator free flap in 1 case. All the anterior thigh perforator free flaps survived completely except 1 case of partial necrosis due to venous congestion. Donor sites were closed primarily and healed uneventfully within 2 weeks. Patients were satisfied with the functionally and aesthetically acceptable results. Although doppler sonography is strongly recommended preoperatively in planning the anterior thigh perforator free flaps, we should always remember the variation in vascular anatomy and be ready to change the flap choice from the anterolateral to anteromedial intraoperatively. we provide a review of the literature and present our series of anterior thigh perforator free flaps for reconstruction of the extremities.

• Archives of Reconstructive Microsurgery
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• v.4 no.1
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• pp.23-32
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• 1995

Severe upper and lower extremity trauma may result in soft tissue loss with exposed bone and the subsequence of risk of chronic osteomyelitis or malunion of fracture fragments. Such injuries present a major reconstructive problem. But Since the introduction of microsugical technique, free muscle and myocutaneous flaps were employed to provide coverage of severely injured defects. Since Tai and Hasegawa(1974) first reported a breast reconstruction using by rectus abdominis myocuraneous flap, the free rectus myocutaneous flap has been widely employed for breast reconstuction, head and neck reconstruction, and extremity reconstruction in these days. The authors present their successful experience with free rectus abdominis muscle and rectus abdominis myocutaneous flaps for upper and low extremity reconstruction. From Nov. 94, to May 95, Five cases of severely injured extremites due to trauma or contact burn were treated with free rectus abdominis muscle flap or free rectus abdominis myocutaneous flap. All flaps except 1 case were survived without severe complications. As free muscle or myocutaneous flap, the free rectus abdominis flap has the advantages of a reliable pedicle, easy dissection, and an acceptable donor site, so it seems logical to apply the free rectus abdominis flap to apply in upper and lower extremity reconstruction.