Perspectives on reconstructive microsurgery in Korea

Byung-Joon Jeon; Goo-Hyun Mun

doi:10.5124/jkma.2011.54.6.604

J Korean Med Assoc > Volume 54(6); 2011 > Article

Jeon and Mun: Perspectives on reconstructive microsurgery in Korea

Focused Issue of This Month

Present and future of plastic and reconstructive surgery in Korea

Journal of the Korean Medical Association

Journal of the Korean Medical Association 2011; 54(6): 604-616.

Published online: June 10, 2011

DOI: http://dx.doi.org/10.5124/jkma.2011.54.6.604

Perspectives on reconstructive microsurgery in Korea

Byung-Joon Jeon, MD, Goo-Hyun Mun, MD

Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Corresponding author: Goo-Hyun Mun, supramicro@gmail.com

Received May 11, 2011 Accepted May 24, 2011

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

With the advancement of modern medicine, there have been increasing demands for reconstructive surgeries. The operative technique using free flaps makes it possible for reconstructive surgeons to restore various defects and deformities more precisely. Furthermore, functional problems, such as facial paralysis and lymphedema, can be managed with microsurgical procedures. The need for the composite tissue allograft, including that of the face, has been noticed, and this transplantation surgery required complex microsurgical procedures. With the very high success rate of free flap and popularization of perforator flap, which provides improved outcomes, reconstructive microsurgeons now play major role in various reconstructive fields.

Reconstruction; Microsurgery; Free flap; Allograft

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Figure 1

Concept change from reconstructive ladder (A) through reconstructive elevator (B) to reconstructive pie.

Figure 2

Preoperative planning with computed tomography (CT) angiography. (A) Transverse view of rendered 3D CT angiography of the abdomen. (B) Coronal view of rendered 3D CT angiography. (C) Evaluation of recipient vessels (in this case, internal mammary vessels are used as recipient vessels) can be done with CT angiography. P, perforating vessels.

Figure 3

Burn scar contracture, scalp. (A) Preoperative view. (B) Flap design (thoracodorsal artery perforator flap). (C) Elevated flap. (D) Two months postoperative view.

Figure 4

Recurred nasopharyngeal cancer, left temporal region. (A) Defect after subtotal petrosectomy. (B) Chimeric pattern anterolateral thigh flap with vastus lateralis muscle. (C) Elevated muscle flap can be used for obliteration of dead space after ablative surgery. (D) Immediate posto-perative view.

Figure 5

Recurred maxillary cancer, right. (A) Defect after extended radical maxillectomy with orbital exenteration. (B) Elevated vertical rectus abdominis musculocutaneous flap and design. (C,D) Fortyone months postoperative view. (E) Intraoral view.

Figure 6

Retromolar trigone cancer, right. (A) Defect after mandibulectomy, right. (B) Flap design, right peroneal region. (C) Elevated fibular osteocutaeous flap. (D) Inset of fibular osteocutaneous flap was done. (E) Three months postoperative view. (F) Split thickness skin graft was done on the donor-site.

Figure 7

Tongue cancer, right. (A) Defect after near total glossectomy. (B) Preoperative computed tomography angiography was done to select appropriate perforators. (C) Design according to the defect. (D) Elevated anterolateral thigh flap. (E) Inset of the flap. (F) Six weeks postoperative view.

Figure 8

Esophageal cancer. (A) Jejunal free flap can be a successful option for esophageal reronstruction. (B) The esophagogram after reconstruction shows patent luminal structure.

Figure 9

Facial nerve schwannoma, left. (A) Preoperative view. (B) Elevated latissimus dorsi muscle flap with thoracodorsal nerve. (C) Seven months postoperative view.

Figure 10

Fibromatosis, sternal region. (A) Defect after radical excision of mass. (B) Elevated deep inferior epigastric artery perforator flap. (C) Immediate postoperative view.

Figure 11

Invasive ductal carcinoma, right. (A) Defect after nipple sparing mastectomy and design of deep inferior epigastric artery perforator flap. (B) Elevated flap. (C,D) Seven months postoperative views.

Figure 12

Paraffinoma, left calf. (A) Defect after radical excision. (B) Preoperative rendered CT angiography for selection of appropriate perforators. (C) Elevated deep inferior epigastric perforator flap with 2 deep inferior epigastric vessels and 2 superficial inferior epigastric veins. (D) Two years postoperative view.

Figure 13

Malignant melanoma, left sole. (A) 3x1.5 cm sized melanoma on the left sole. (B) Elevated thoracodorsal artery perforator flap. (C) Fifteen months postoperative view of donor-site. (D) Fifteen months postoperative view.

Figure 14

Lymphedema, left calf. (A) Preoperative view. (B) Three slit incisions were done. (C) Lymphaticovenular anasto-mosis. (D) Three months postoperative view.