Clinical microsurgery is a field in which many medical scholars have centered their interest over the past two decades, and one’s experience with microvascular surgery has changed their fundamental approach to reconstructive plastic surgery.
Based on new understanding of anatomy, physiology, function, and surgical technique, the previous somewhat rigid concept of vascular surgery has now become generalized one, sometimes involving multiple tissue components, such as skin, muscle, bone, or the gastrointestinal tract, Compared with traditional methods, these new microsurgical techniques are better not only in functional and cosmetic results, but also in cost.
In the Department of Plastic and Reconsturctive Surgery, School of Medicine, Keimyung University, 5 free flap transfers were performed for skin coverage.
In our small series, five different donor sites were selected in 5 patients. One was as musculocutaneous flap, the others were free skin flaps. The case sas a 33-year-old woman, who had a depressed scar and deformity in the right hand following treatment of an open fracture and excision of the scar and free groin skin flap was performed. The second case was a 43-year-old woman who had suffered,the from a contact burn on the left elbow. After all necrotic tissue had been debrided, the radio-humeral joint in addition to the soft tissue defect was exposed and was covered by a free latissimus dorsi myocutaneous flap. In the third case chronic osteomyelitis and soft tissue defects due to an electrical burn were noted in the lower one third of the right ulna and were covered with a free parascapular flap.
In the fourth case a medial thigh flap was selected for the full thickness defect on the dorsum of the left hand. The fifth case, a 16-year-old boy, who could not right his head due to a severe burn scar contracture between the left cheek and neck who was treated with a free forearm flap following scar excision.
The results were summerized as follows:
1. The greatest advantage of a groin flap is the ability to conceal the donor scar with even brief clothing. However, short vascular pedicle, the small size of the vessel, anatomic variability, difficult dissection, and bulkiness are disadvantages.
2. In the latissimus dorsi myocutaneous flap, the length of the vascular pedicle is longer and caliber of the vessel is larger than a groin flap. Due to the rich blood supply in the muscle, contaminated wounds are best resurfaced with a musculocutaneous flap than with a skin flap.
3. The parascapular flap is of uniform thickness and paired venae comitantes have been found. Its size, ease of dissection, and long vascular pedicle have made it a very useful skin flap. However, a conspicuous scar extending vertically at the it a very useful skin flap. However, a conspicuous scar extending vertically at the back of the shoulder limit its use in women.
4. The medial thigh flap has a large amount of skin, a long vascular stalk with a large vessel diameter and predictable anatomy. However, the donor site may leave a slight contour defect, or require grafting when a large flap is taken. The flap seems to be bulky and hairy in our female case.
5. Since the forearm flap has a fine skin texture, thin subcutaneous tissue, long and big vessels, constant anatomy and a large donor area, it is considered to be adequate for reconstructive surgery of the head and neck. It is a disadvantage that the frafted donor site is exposes and unsightly
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