Surgical outcomes of suprafascial and subfascial radial forearm free flaps in head and neck reconstruction

Sae Hwi Ki,Tae Jun Park,Jin Myung Yoon Korean Cleft Palate-Craniofacial Association 2023 Archives of Craniofacial Surgery Vol.24 No.3

Background: Conventional radial forearm free flaps (RFFFs) are known to be safe, but can result in donor site complications. Based on our experiences with suprafascial and subfascial RFFFs, we evaluated the safety of flap survival and surgical outcomes. Methods: This was a retrospective study of head and neck reconstructions using RFFFs from 2006 to 2021. Thirty-two patients underwent procedures using either subfascial (group A) or suprafascial (group B) dissection for flap elevation. Data were collected on patient characteristics, flap size, and donor and recipient complications, and the two groups were compared. Results: Thirteen of the 32 patients were in group A and 19 were in group B. Group A included 10 men and three women, with a mean age of 56.15 years, and group B included 16 men and three women, with a mean age of 59.11 years. The mean defect areas were 42.83 cm² and 33.32 cm², and the mean flap sizes were 50.96 cm² and 44.54 cm² in groups A and B, respectively. There were 13 donor site complications: eight (61.5%) in group A and five (26.3%) in group B. Flexor tendon exposure occurred in three patients in group A and in none in group B. All flaps survived completely. A recipient site complication occurred in two patients (15.4%) in group A and three patients (15.8%) in group B. Conclusions: Complications and flap survival were similar between the two groups. However, tendon exposure at the donor site was less prevalent in the suprafascial group, and the treatment period was shorter. Based on our data, suprafascial RFFF is a reliable and safe procedure for reconstruction of the head and neck.

Reconstruction with an Anterolateral Thigh Free Flap Following a Skin Graft from the Same Donor Site for Tissue Use Efficacy: Two Case Reports

Sae Hwi Ki,Tae Jun Park,Jin Myung Yoon 대한창상학회 2023 Journal of Wound Management and Research Vol.19 No.2

The coverage of extensive soft tissue defects requires several considerations, such as limited donor sites, reconstruction methods, and the outcome of functional recovery. In the cases described herein, when a significant soft tissue defect was present on an extremity, we opted for staged reconstruction. We first performed a split-thickness skin graft (STSG) to reduce the soft tissue defect, using the anterolateral thigh (ALT) as the donor site. In the second stage, the remaining soft tissue defect was reconstructed with an ALT free flap, utilizing the same lateral thigh area that had previously served as the STSG donor site. After the free flap procedure, we encountered several challenges in monitoring the ALT flap; however, all flaps ultimately survived. To the best of our knowledge, this is the first report of using an ALT free flap following STSG from the same donor site, demonstrating efficient tissue utilization. We believe this approach is beneficial for reconstructing extensive soft tissue defects, as it maximizes tissue use efficiency and reduces donor site morbidity when donor options are limited.

Risk and Effectiveness of Using Thrombin in Microvascular Free Tissue Transfer

Ki, Sae Hwi,Kim, Han Joon 대한미세수술학회 2014 Archives of reconstructive microsurgery Vol.23 No.1

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.

Early surgical correction of microstomia following Stevens-Johnson syndrome

Ki, Sae Hwi,Jo, Gang Yeon,Ma, Sung Hwan,Choi, Matthew Seung Suk Korean Cleft Palate-Craniofacial Association 2020 Archives of Craniofacial Surgery Vol.21 No.2

Stevens-Johnson syndrome (SJS) is a rare disease in which extensive toxic epidermolysis occurs after medication. Skin and mucous membranes are involved in about 90% of SJS cases, and webbing of mouth corners (microstomia) may occur when they are affected. Few reports have been issued on microstomia in SJS, and no consensus has been reached regarding treatment methods, timings, or results. We encountered a case of microstomia following SJS after ofloxacin medication in a 22-year-old woman treated by commissuroplasty using a lozenge-shaped excision. We present an appropriate correction method and surgical timing for microstomia following SJS.

Reconstruction of microstomia considering their functional status

Ki, Sae Hwi,Jo, Gang Yeon,Yoon, Jinmyung,Choi, Matthew Seung Suk Korean Cleft Palate-Craniofacial Association 2020 Archives of Craniofacial Surgery Vol.21 No.3

Background: Microstomia is defined as a condition with a small sized-mouth that results in functional impairment such as difficulty with food intake, pronunciation, and poor oral hygiene and cosmetic problems. Several treatment methods for microstomia have been proposed. None of them are universally applicable. This study aims at analyzing the cases treated at our institution critically reviewing the pertinent literature. Methods: The medical records of all microstomia patients treated in our hospital from November 2015 to April 2018 were reviewed retrospectively. Of these, all patients who received surgical treatment for microstomia were included in the study and analyzed for etiology, chief complaint, surgical method, and outcomes. The functional outcomes of mouth opening and intercommissure distance before and after the surgery were evaluated. The cosmetic results were assessed according to the patients' satisfaction. Results: Five patients with microstomia were corrected. Two cases were due to scar contracture after chemical burn, two cases derived from repeated excision of skin cancer, and one patient suffered sequela of Stevens-Johnson syndrome. The following surgical methods were applied: one full-thickness skin graft on the buccal mucosa, three buccal mucosal advancement flaps after triangular excision of the mouth corner, and one local buccal mucosal flap. Mouth opening was increased by 6.0 mm, and the intercommissure distance improved by 7.2 mm on average. Follow-up was 9.6 months (range, 5-14 months). Cosmetic assessment was as follows: two patients found the results excellent, three judged it as good. Conclusion: Microstomia has several causes. In order to achieve optimal functional recovery and aesthetic improvement it is important to precisely evaluate the etiologic factors and the severity of the impairment and to carefully choose the appropriate surgical method.

Reconstruction of Fingertip Amputation: Necrosis Is Expected

Ki, Sae Hwi Korean Society of Plastic and Reconstructive Surge 2012 Archives of Plastic Surgery Vol.39 No.4

Reconstruction of Multiple Digital Defects by Temporary Syndactylization Using a Lateral Arm Free Flap

Sae Hwi Ki,Jin Myung Yoon,Tae Jun Park,M. Seung Suk Choi,Min Ki Hong 대한성형외과학회 2022 Archives of Plastic Surgery Vol.49 No.6

Background Soft tissue defects of the multiple finger present challenges to reconstruction surgeons. Here, we introduce the use of a lateral arm free flap and syndactylization for the coverage of multiple finger soft tissue defects. Methods This retrospective study was conducted based on reviews of the medical records of 13 patients with multiple soft tissue defects of fingers (n¼33) that underwent temporary syndactylization with a microvascular lateral arm flap for temporary syndactylization from January 2010 to December 2020. Surgical and functional outcomes, times of flap division, complications, and demographic data were analyzed. Results Middle fingers were most frequently affected, followed by ring and index fingers. Mean patient age was 43.58 years. The 13 patients had suffered 10 traumas, 2 thermal burns, and 1 scar contracture. Release of temporary syndactyly was performed 3 to 9 weeks after syndactylization. All flaps survived, but partial necrosis occurred in one patient, who required a local transposition flap after syndactylization release. The mean follow-up was 15.8 months. Conclusion Coverage of multiple finger defects by temporary syndactylization using a free lateral arm flap with subsequent division offers an alternative treatment option.

Discussion: Reconstruction of Fingertip Amputation: Necrosis Is Expected

Sae Hwi Ki 대한성형외과학회 2012 Archives of Plastic Surgery Vol.39 No.4

Unplanned change from double free flap to a chimeric anterolateral thigh flap in recurrent laryngeal cancer

Ki, Sae Hwi,Ma, Sung Hwan,Sim, Seung Hyun,Choi, Matthew Seung Suk Korean Cleft Palate-Craniofacial Association 2019 Archives of Craniofacial Surgery Vol.20 No.6

Reconstruction method choice in recurrent head and neck cancer depends on surgical history, radiation therapy dosage, conditions of recipient vessels, and general patient condition. Furthermore, when defects are multiple or three dimensional in nature, reconstruction and flap choice aimed at rebuilding the functional structure of the head and neck are difficult. We experienced successful reconstruction of recurrent laryngeal cancer requiring reconstruction of esophageal and tracheostomy stroma defects using a chimeric two-skin anterolateral thigh flap with a single pedicle.

Location of the Mandibular Branch of the Facial Nerve According to the Neck Position

Hwang, Kun,Huan, Fan,Ki, Sae Hwi,Nam, Yong Seok,Han, Seung Ho Mutaz B. Habal, MD 2012 JOURNAL OF CRANIOFACIAL SURGERY - Vol.23 No.5

ABSTRACT: The aim of this study was to elucidate the exact location of the mandibular branch of the facial nerve according to different neck positions.Twenty-two hemifaces of 11 fresh human cadavers were used (age range, 53–89 y; mean age, 72.3 ± 10.5 y; 8 men and 3 women). Working through skin windows, the distance from the mandibular border to the mandibular branch of the facial nerve (border–nerve distance or BND) was measured at 3 points: (1) the mandible angle (gonion or Go point), (2) the point where the mandibular branch of the facial nerve crosses the facial artery (FA point), and (3) the one-fourth point from the gonion to the menton (1/4 point). Threads were hung on the skin windows along the mandibular border. With the neck in the neutral position and then full flexion (15 degrees), extension (15 degrees), and left and right rotations (30 degrees), the distance of the mandibular branch from the thread of the mandibular border was measured using calipers.In the neutral position, the mandibular branch was 3.50 ± 2.82 mm above the mandibular border at the Go point, 5.34 ± 2.98 mm above the mandibular border at the FA point, and 5.28 ± 1.86 mm above the mandibular border at the 1/4 point. At all 3 points, flexion or extension of the neck did not significantly move the mandibular branch. At the Go point and FA point, there was no significant difference between the ipsilateral rotation position and the contralateral rotation. Yet at the1/4 point, the BND decreased (4.32 ± 2.60 mm) with the neck in ipsilateral rotation and the BND increased (5.97 ± 2.62 mm) with the neck in contralateral rotation. There was a significant difference between the ipsilateral rotation position and the contralateral rotation position (P = 0.020, t-test).Surgeons should keep in mind that at the 1/4 point, the mandibular branch of the facial nerve moves downward 1.10 ± 1.42 mm with the neck in ipsilateral rotation and moves upward 0.49 ± 1.84 mm with the neck in contralateral rotation.