Jae Duk Lew

Replantation and revascularization of hands: Clinical analysis and functional results of 261 cases

During the past 4 years we performed 261 replantations and revascularizations on amputated digits and hands in 153 patients. The overall survival rate was 82%. Clean-cut proximal level amputations and hypothermically preserved amputation parts had the highest survival rate. A higher survival rate and more satisfactory results with accelerated return of sensory function correlated with repair of both digital arteries and two veins rather than only one. All patients experienced intolerance to cold, but this was more troublesome in patients with digital replantation in whom only a single artery was repaired. Digital sensibility and joint motion after replantation were better in these patients who had sharp amputations and on whom repairs were carried out in zone III. Return of intrinsic muscle function after hand replantation was poor; however, patient satisfaction with the procedures remained high.

A New Arterial Flap from the Postauricular Surface: Its Anatomic Basis and Clinical Application

We studied the arterial pattern of the postauricular surface in 16 cadavers and compared them to the results of Doppler probing in the auricles of 15 human volunteers. The dissections revealed that the postauricular surface is mainly supplied by three to five sizable branches from the upper, middle, and lower divisions of the posterior auricular artery, traversing in a rather straight and cephalic direction toward the auricular rim. One or more branches of the middle division are constantly present and distribute over the upper two-thirds of the postauricular surface. These anatomic findings were compatible with the results of the Doppler probing. We have done four auricular reconstructions with postauricular arterial flaps with excellent postoperative results. It is worthwhile to use the postauricular arterial flap in restoring the middle third of the auricle.

Reduction mammaplasty by central pedicle flap with short submammary scar

Reduction mammaplasty was performed in 30 patients by combining the central pedicle flap method with the short submammary scar (3-S) technique to avoid the common drawbacks of currently popular dermoglandular procedures. Reduction was accomplished by using perforating vascular branches from the pectoralis major muscle and its fascia supplying the nipple and breast parenchyme instead of the subdermal plexus. The central vascular pedicle supplying the nipple-areola complex was preserved. Only the periphery of the breast parenchyme was resected circumferentially, with the exception of the inferolateral portion, so as not to injure the sensory nerve. The remaining breast parenchyme was preserved in an inverted cone shape. The nipple-areola complex was safely transposed with great freedom, and the amount of resection was accurately adjusted for symmetry. No cases of nipple-areola complex sensory change occurred postoperatively, and lactation is possible because of preservation of the lactiferous ducts. The length of postoperative scars was reduced by using the short submammary scar technique. We believe this combined method is ideal in patients requiring resections ranging from 200 to 600 g per breast with good skin elasticity and moderate degree of ptosis.

Nostril sill augmentation in secondary cleft lip.

In most cases, after successful correction of primary cleft lip deformity, some problems remain to be solved. One of them is nostril sill depression, which should not be overlooked in cleft lip repair. However, there have been few reports on the anatomy of the depressed nostril sill and methods for augmenting the sill depression. The anatomy of the depressed nostril sill, its relationship to surrounding tissue, and the gross features of nostril sill depression in cleft lip deformity were reviewed, and a method in which a scar flap and a suture-fixation technique are used was developed for augmenting the depression. The clinical results of this method in 16 patients are presented.

Restoration of finger extension and forearm contour utilizing a neurovascular latissimus dorsi free flap.

The use of a free neurovascular latissimus dorsi flap for restoration of wrist and finger extension and forearm contour is described in a burn patient. Wound coverage is the prime need of the extensive tissue loss in the upper limb, and a muscle or musculocutaneous flap is necessary to cover the exposed bone and muscles for infection control. Furthermore, restoration of the limb function as well as aesthetic flap donor and recipient site contour are needed. The case presented is the extremely rare patient in whom restoration of finger extension was achieved after the nearly total loss of the extensor forearm muscles.

The Short-Lip Deformity after Triangular Flap Repair: A Lengthening Technique

A method for lengthening of the short lip after triangular-flap repair of the unilateral cleft lip is documented. This technique offers a minimal additional scar line and a maximum effect.