Regional Analysis of Soft Tissue Thickness on Korean Buttocks and Application to Fasciocutaneous Flap Design

BACKGROUND: Various shapes and designs of the gluteal artery perforator flap have been used for treating sacral pressure sores and reconstructing breasts. To establish the ideal fasciocutaneous flap design for use in the gluteal area, the soft tissue thickness distribution was measured. METHODS: Twenty-one buttocks of adult Korean cadavers were analyzed through rectangular subfascial dissection. Each buttock was divided horizontally into 10 sections and vertically into 10 sections, and then, the thickness at the corners of the sections was measured. For the sake of comparison and statistical verification with living bodies, computed tomography (CT) images of 120 buttocks of patients were randomly selected. Five horizontal sections and 4 vertical sections were made, and the thickness at each corner was recorded. RESULTS: According to the dissection and the CT images, the area with the thinnest soft tissues in the buttock was around the posterior superior iliac spine, close to the sacral area. The thickest area was the superolateral area of the buttock, which was 3.24 times and 2.15 times thicker than the thinnest area in the studies on cadaver anatomy and the CT images, respectively. CONCLUSIONS: The thickness of the soft tissues in the buttocks differed by area. The superolateral area had the thickest soft tissues, and the superomedial area had the thinnest. This study includes information on the distribution of the thickness of the gluteal soft tissues of Koreans. The outcome of this study may contribute to the design of effective local flaps for pressure sore reconstruction and free flaps for breast reconstruction.

The Effect of Platelet-Rich Plasma on Survival of the Composite Graft and the Proper Time of Injection in a Rabbit Ear Composite Graft Model

BACKGROUND: Administration of growth factors has been associated with increased viability of composite grafts greater than 1-cm in diameter. Platelet-rich plasma (PRP) contains many of the growth factors studied. In this study, we evaluate the effect of PRP injection on composite graft viability and the proper time for injection. METHODS: A total of 24 New Zealand White rabbits were divided into four groups. Autologous PRP was injected into the recipient sites three days before grafting in group 1, on the day of grafting in group 2, and three days after grafting in group 3. Group 4 served as control without PRP administration. Auricular composite grafts of 3-cm diameter were harvested and grafted back into place after being rotated 180 degrees. Median graft viability and microvessel density were evaluated at day 21 of graft via macroscopic photographs and immunofluorescent staining, respectively. RESULTS: The median graft survival rate was 97.8% in group 1, 69.2% in group 2, 55.7% in group 3, and 40.8% in the control group. The median vessel counts were 34 (per x200 HPF) in group 1, 24.5 in group 2, 19.5 in group 3, and 10.5 in the control group. CONCLUSIONS: This study demonstrates that PRP administration is associated with increased composite graft viability. All experimental groups showed a significantly higher survival rate and microvessel density, compared with the control group. Pre-administration of PRP was followed by the highest graft survival rate and revascularization. PRP treatments are minimally invasive, fast, easily applicable, and inexpensive, and offer a potential clinical pathway to larger composite grafts.

Application of Digital Infrared Thermographic Imaging (DITI) in the Monitoring of Change of Skin Temperature about Vascular Supply of Lower Abdominal Axial Flap in the Rabbit / 고신대학교의과대학학술지

OBJECTIVES: Monitoring viability of flap is important. The flap survival depends on the vascularity of the flap, on which the skin temperature depends. The authors applied digital infrared thermographic imaging (DITI) for monitoring the vascular supply of the flap and for the prediction of the prognosis of the flap survival. METHODS: Eight male New Zealand white rabbits with average weight of 3kg were used. A 10 x 10 cm unipedicled fasciocutaneous island flap was elevated based on the left superficial inferior epigastric vessel. The surface temperatures on designed flap were checked with DITI for 24 hours after the operation. On 14th day after the operation, the surviving area was measured and compared with DITI image which was taken on 24 hours after the operation using digital analysis software ImageJ. Statistical analysis was evaluated by paired T-test. RESULTS: On DITI image 24 hours after the flap elevation, distal portion of the flap showed remarkable color change. The average percentage and the standard deviation of the survival area of the flap which is predicted by DITI and the average percentage and the standard deviation of the survival area of the flap which was actually measured 2 weeks after flap elevation were 55.3 (16.6), 56.2 (18.0), respectively. This shows no significant difference between the two. CONCLUSIONS: This study shows that DITI system could be used in evaluation of flap vascularity with ease, quickness and safety for patient and flap. Thus, it could be used clinically for the prediction of flap survival.

A New Method for Creating a Definite Philtrum by the Flipping of an Orbicularis Oris Muscle Flap in a Patient with an Indistinct Philtrum

The philtrum plays a key role in the appearance of the upper lip and nostril sill. Therefore, construction of the philtrum is crucial for attaining a natural appearance of the upper lip. We used a flipping myoplasty of the orbicularis oris muscle on a patient with a flat philtrum in order to effectively reconstruct the philtral dimple and column. A 35-year-old female presented to our department with the complaint of a flat upper lip. A superficial layer of the orbicularis oris muscle on the median aspect of the upper lip was vertically incised and elevated to a thickness of 2 mm. Both sides of the elevated muscle flap were then folded to the lateral sides so that the border could be sutured onto the outer portion of the orbicularis oris muscle. The patient was observed for one year postoperatively. Her philtrum deepened by 1.25 mm, with the central angle of her Cupid's bow improving from a preoperative measurement of 146degrees to 128degrees postoperatively. In a patient with an indistinct philtrum, a flipping orbicularis oris myoplasty was performed to attain a definite philtral column and a philtral dimple. Natural upper lip movement was maintained, and an aesthetically and functionally satisfactory reconstruction was achieved.

Palatal Fistula of a Healthy Adult after an Infectious Disease: A Case Report

PURPOSE: In rare cases, infectious disease can become the cause of palatal fistula as it usually occurs in immunocompromised patients. We are reporting this case because we have successfully reconstructed palatal fistula occurring due to infectious disease in a healthy adult. METHODS: A 62-year-old female patient had visited our hospital with a palatal hole that had occurred after suffering from a severe febrile disease. An oro-nasal fistula measuring 1.5 x 1.3 cm has been observed in the junction of the soft palate and hard palate, and is presumed to be caused by an infectious disease according to the patient's history. It was reconstructed using a hinge flap and a mucoperiosteal flap. RESULTS: For 6 months, no recurrence or complications had been observed. The post operative patient was satisfied with the improvement in nasal speech and fluid regurgitation. CONCLUSION: We reported this case since we had obtained a functionally satisfactory result by reconstructing the palatal fistula due to infectious disease in a healthy adult.

Palatal Fistula of a Healthy Adult after an Infectious Disease: A Case Report

PURPOSE: In rare cases, infectious disease can become the cause of palatal fistula as it usually occurs in immunocompromised patients. We are reporting this case because we have successfully reconstructed palatal fistula occurring due to infectious disease in a healthy adult. METHODS: A 62-year-old female patient had visited our hospital with a palatal hole that had occurred after suffering from a severe febrile disease. An oro-nasal fistula measuring 1.5 x 1.3 cm has been observed in the junction of the soft palate and hard palate, and is presumed to be caused by an infectious disease according to the patient's history. It was reconstructed using a hinge flap and a mucoperiosteal flap. RESULTS: For 6 months, no recurrence or complications had been observed. The post operative patient was satisfied with the improvement in nasal speech and fluid regurgitation. CONCLUSION: We reported this case since we had obtained a functionally satisfactory result by reconstructing the palatal fistula due to infectious disease in a healthy adult.