Cross-Leg Achilles Tendon Reconstruction Using a Composite Flap of Dorsalis Pedis and Tendon Strips of the Extensor Digitorum Longus in a Vascular Compromised Wound

Reconstructions of soft tissue defect of the posterior ankle including Achilles the tendon should take into account not only coverage but functional outcome. Various methods of tendon transfer and tendon graft have been reported as a single-stage procedure. With advances and refinements in microsurgical techniques, several free composite flaps including tendon, fascia, or nerve have been used in single-stage reconstructions of large defects in this area minimizing further damage to the traumatized leg. However, when free flap is not feasible for some reasons, this cannot be accomplished successfully. Here we present a patient with Achilles tendon and circumferential large soft tissue defect. Because of circulatory compromise of the lower extremity, free flap reconstruction could not be applied. Instead, cross-leg composite flap of the dorsalis pedis flap including the extensor hallucis brevis musle and tendon, and tendon strips of the Second, third and fourth extensor digitorum logus were employed, Functional reconstruction of the tendon and resurfacing were obtained at the same time. The flap was detached 3 weeks postoperatively, and the transplanted flap has survived without any complications. By 3 months after surgery, full weight bearing, tip-toe standing and even walking without crutch assistance was possible. When functional reconstruction with the free flap is unattainable in the large defect of the posterior ankle including the Achilles tendon, cross-leg composite island flap of dorsalis pedis flap and tendon strips of the extensor digitorum longus tendon is a viable alternative.

A Case of Facial-nerve Neurofibroma in Parotid Gland

The incidence of solitary neurofibroma of the facial nerve originating from the parotid region is extremely low, and there are two cases reported in Korea to our knowledge. We report a case of neurofibroma in parotid gland in a 17-year-old male. The patient had a slow growing, nontender parotid mass on the right side without facial paralysis & lymphadenopathy. He had systemic neurofibromatosis and family history. CT scan showed a 3x3cm sized eliptical, well demarkated mass that was located in the anterior portion of the superficial lobe and outside of masseter muscle. The mass was well-enhanced and surgically removed with minimal nerve injury. Histopathologic examination indicated neurofibroma. Thus, we report this case to discuss intraparotid neurofibroma compared with Schwannoma.

A Case of Three Triangular Flaps as a Secondary Operative Procedure after Reconstruction of the Lower Lip by Estlander's Method

Estlander's method was popular for lower lip reconstruction after wide excision of malignant tumor of lower lip. This operative method is safe, easy and has good result, but it is necessary to perform a secondary commissuroplasty because of round and small commissure. Several methods have been suggested for secondary commissuroplasty. We have performed commissuroplasty with three triangular flaps according to Ichiro's report.5 This method uses two opposing triangular mucosal flaps in the vermilion area and one small triangular skin flap on the commissure. We can obtain satisfactory results in terms of aesthetic and functional consideration. Thus, we report the usefulness of three triangular flaps as a secondary commissuroplasty after reconstruction of the lip by Estlander's method.