Kyung Suk Lee

An anatomic study of the superficial peroneal nerve accessory artery and its perforators, and clinical application of superficial peroneal nerve accessory artery perforator flaps.

In the 1990s, skin island flaps supplied by the vascular axis of sensitive superficial nerves, like the sural and saphenous nerves, were introduced. Flaps supplied by the superficial peroneal nerve accessory artery (SPNAA), however, are still not commonly used. The aim of this study is to understand the anatomic structure of the SPNAA and its perforators in the anterior intermuscular septum and to use SPNAA perforator flaps in the clinic. We dissected 16 cadavers and assessed the location and number of the SPNAA, its perforators, and the septocutaneous perforators originating from the anterior tibial artery. A SPNAA perforator flap was applied to 12 patients, the free flap was applied to 11 patients, and the pedicled flap was applied to 1 patient. SPNAA varied from 7 to 16 cm in length, with an average of 4.5 perforators to supply the lateral aspect. An average of 3.13 septocutaneous perforators originated from the anterior tibial artery. The mean size of the SPNAA perforator flaps was 65.5 cm2. The complete follow-up period was 3–20 months. Although 1 flap was lost as a result of arterial thrombosis, the procedure was successful in the remaining 11 patients. In addition, reduced flap thickness made them more esthetically appealing. SPNAA perforator flaps could be an excellent alternative to perforator flaps that use the lower leg as a donor site.

Statistical analysis of surgical dog-ear regression.

BACKGROUND Several methods have been developed to prevent or correct dog-ears. Most of these methods, however, result in prolonged scars and operative times. OBJECTIVE We observed dog-ears without correction to examine the regression of dog-ears with time. METHODS The study was performed on 43 cases of dog-ears in 26 patients. Linear regression analysis was performed to examine the correlation between various factors and the height of the dog-ears (%). We produced a regression equation to allow prediction of the height of the dog-ears (%). In addition, we estimated the initial height of the dog-ears that should be removed during surgery. RESULTS The height of dog-ears regressed with time, and this response was better in younger and female patients. It was predicted that the time taken for a dog-ear to reduce to 50% of its original height was 20.697 days; the median time at which dog-ears completely regressed was 132 days. The odds of regression of dog-ears with an initial height of ≤8 mm was 4.667 times greater than that of larger dog-ears. CONCLUSIONS If the height of a dog-ear is ≤8 mm, we recommend observation rather than immediate surgical removal.

Free Flap Reconstruction of Head and Neck Defects after Oncologic Ablation: One Surgeon's Outcomes in 42 Cases

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.

Comparison of endoscopic endonasal reduction and transcaruncular reduction for the treatment of medial orbital wall fractures.

Currently, endoscopic endonasal reduction and transcaruncular reduction are frequently used as surgical treatments for medial orbital wall fractures. However, these 2 surgical techniques have not been comprehensively compared using objective criteria. Therefore, the results of these 2 techniques were compared retrospectively using 8 objective criteria in patients with medial orbital wall fracture. This study included 48 medial orbital wall fracture patients treated from June 1993 to July 2006: 29 had endoscopic endonasal reduction and 19 had transcaruncular reduction. Computed tomographic scans, double vision field testing for diplopia using Goldmann perimetry, and Hertel exophthalmometer (Richmond Products, Albuquerque, NM) were done pre- and postsurgery. The average follow-up period was 70.8 months. Among patients with pure medial orbital wall fractures, the average reduction rate was 89.2% for the endoscopic endonasal reduction group and 90.7% for the transcaruncular reduction group. One case in the endoscopic endonasal reduction group had a more than 2-mm enophthalmos after surgery. The diplopia correction rate was 1.8% in the endoscopic endonasal reduction group and 2.7% in the transcaruncular reduction group. None of the above differences was statistically significant. However, among patients with pure medial orbital wall fractures compared with the transcaruncular reduction group, the average operation time, the average hospital stay, and the average cost were significantly greater in the endoscopic endonasal reduction group. The 2 surgical methods had a similar effectiveness; however, transcaruncular reduction seemed to be more advantageous with respect to the operation time, the length of hospital stay, and cost.

Flow-through arterialised venous free flap using the long saphenous vein for salvage of the upper extremity

We used two flow-through arterialised venous free flap transfers with the long saphenous vein to reconstruct major arteries and injured skin and soft tissues in the upper extremity. Operating time was reduced, only one donor site was used, and reconstruction of a long arterial defect (24-25 cm) was possible.We used two flow-through arterialised venous free flap transfers with the long saphenous vein to reconstruct major arteries and injured skin and soft tissues in the upper extremity. Operating time was reduced, only one donor site was used, and reconstruction of a long arterial defect (24–25 cm) was possible.

Soft palate reconstruction using bilateral palatal mucomuscular flap and pharyngeal flap after resection of squamous cell carcinoma.

Squamous cell carcinoma infrequently occurs at the soft palate. Although various methods can be used for reconstruction of soft palate defects that occur after resecting squamous cell carcinoma, it is difficult to obtain satisfactory results from the perspective of the functional restoration of the soft palate. A combination of bilateral palatal mucomuscular flap for the oral side and superiorly based posterior pharyngeal flap for the nasal side were performed on two patients who were diagnosed with squamous cell carcinoma of the soft palate in order to reconstruct the soft palate defects after surgical resection. After surgery, the patients were followed-up for a mean period of 11 months. The flaps were well maintained in both patients. The donor site defects were epithelialized and completely recovered. Additionally, no recurrence of the primary sites was shown. Slight hyponasality was observed in the voice assessments that were conducted 6 months after surgery. No food regurgitation or aspiration was observed in the swallowing tests. We used a combination of bilateral palatal mucomuscular flap and superiorly based posterior pharyngeal flap to reconstruct the soft palate defects that occurred after resecting the squamous cell carcinomas. We reduced the donor site complications and achieved functionally satisfactory outcomes.

Redoable Tie-Over Dressing Using Multiple Loop Silk Threads

After skin grafting, to prevent hematoma or seroma collection at the graft site, a tie-over dressing has been commonly used. However, although the conventional tie-over dressing by suture is a useful method for securing a graft site, refixation is difficult when repeated tie-over dressing is needed. Therefore, we recommend a redoable tie-over dressing technique with multiple loops threads and connecting silk threads. After the raw surface of each of our cases was covered with a skin graft, multiple loop silk thread attached with nylon at the skin graft margin. We applied the ointment gauze and wet cotton/fluffy gauze over the skin graft, then fixed the dressing by connecting cross-counter multiple loop thread with connecting silk threads. When we opened the tie-over dressing by cutting the connecting silk threads, we repeated the tie-over dressing with the same method. The skin graft was taken successfully without hematoma or seroma collection or any other complications. In conclusion, we report a novel tie-over dressing enabling simple fixation of the dressing to maintain proper tension for wounds that require repetitive fixation. Further, with this reliable method, the skin grafts were well taken.

Treatment of chronic tophaceous gout with a free flap.

A 62-year-old man who suffered from severe deforming arthritis, secondary to chronic tophaceous gout with multilobular, solid, tender, enlarged subcutaneous nodules, and draining tophi in right second finger, was treated by free flap and finally got the more functional and aesthetic result.

Primary Necrotizing Fasciitis of the Breast in an Untreated Patient with Diabetes

Necrotizing fasciitis (NF) is a soft tissue infection that can be fatal. Diagnosis may be delayed because NF is easily misdiagnosed as an abscess or cellulitis [1]. It is commonly found in the extremities, perineum, and abdominal wall, but rarely in the breast. NF of the breast can be caused by previous surgery (e.g., mastectomy, implant augmentation) or trauma [2]. In this report, we present a rare case of primary NF of the breast in a patient with untreated diabetes.

Are gender differences in external noses caused by differences in nasal septal growth

BACKGROUND The nasal septum plays an important role in nasal growth, but there have been few reports on the relationship between the septum and nasal growth. The authors investigated the relationship between septa and external noses using computed tomography during the growth period. METHODS One hundred and ninety-eight patients under the age of 21 were enrolled in this study between 2008 and 2012. The authors evaluated a total of 9 measurement items (five for nasal bones and septa, and four for external noses). RESULTS In the final age group, most measurement items were significantly larger in males than in females. However, there was no remarkable difference between male and female growth processes. Nasal bridge length and nasal height were significantly correlated with the nasal bone or septum in almost all age groups. The relative proportion of the cartilaginous septum decreased significantly with age, and was negatively correlated with the perpendicular plate in all age groups. CONCLUSIONS Nasal septa and external noses were both larger in males than in females at the beginning of the study period, although not significantly. The differences became significant throughout the study due to differential increases between the sexes during the monitored growth spurts.