Joon Pio Hong

University of Ulsan, Urusan, Ulsan, South Korea

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Publications (64)116.94 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Distant free flaps have become a routine option for reconstruction of large, complicated facial soft tissue defects. The challenge is to find a flap that is pliable to provide good contour and function. The purpose of this paper was to evaluate the use of superficial circumflex iliac artery perforator (SCIP) flaps for facial defects.From November 2010 to June 2013, facial reconstruction was performed on 6 patients (age range, 15-79 years). The harvesting technique was modified to elevate above the deep fat, and the pedicles were taken above or just below the deep fascia. The mean size of the flap was 75.6 cm, with a thickness of 7 mm; the mean pedicle length was 4.9 cm; and the mean artery caliber was 0.7 mm. The supermicrosurgery technique was used successfully in all 6 cases. Donor sites were all closed primarily. The mean follow-up was 16.7 months.All flaps survived without flap loss, and the donor sites healed without complications including lymphorrhea. The patients were satisfied with contour and function after reconstruction.The result of these 6 cases suggested that the SCIP flap can be a reliable flap for moderate-sized to large defects in the face. The use of new instrumentation and supermicrosurgical techniques allows use of the SCIP flap reliably while providing patients with a good contour, function, and minimal donor site morbidity.
    The Journal of craniofacial surgery. 10/2014;
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    ABSTRACT: Background Microsurgical technique in reconstructive surgery is important. Despite recognizing this fact, there are no systematized microsurgery training programs in Korea. The purpose of this study was to diagnose the current training programs and discuss the direction that is needed to improve them. Methods The authors conducted a survey of graduates of a plastic surgery residency program. The questionnaire included the volume of microsurgery, training environment, area of microsurgery, department(s) performing microsurgery, and the frequency with which flaps were used. Results Many specialties other than plastic surgery involved microsurgical procedures. The volume of microsurgery cases was disproportionate between large and small hospitals, creating an imbalance of residents' experience with microsurgical procedures. The increase in microsurgical procedures being performed has increased the number of surgeons who want to train in microsurgery. Conclusion Increasing the number of microsurgery training programs will create more microsurgeons in Korea.
    Journal of Reconstructive Microsurgery 07/2014; · 1.00 Impact Factor
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    ABSTRACT: Closed incisional wound surgery frequently leaves dead space under the repaired skin, which results in delayed healing. The purpose of this study was to evaluate the effect of negative pressure wound therapy (NPWT) on incisional wounds with dead space after primary closure by evaluating the fluid volume through the suction drain, blood flow of the skin, tensile strength, and histology of the wounds.
    Annals of plastic surgery. 07/2014;
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    ABSTRACT: This study was conducted to evaluate the effects of foam dressing with human recombinant human epidermal growth factor (rhEGF) on the healing process in head and neck cancer patients who experience radiation-induced dermatitis (RID). Seven patients, including three with oropharyngeal, two with nasopharyngeal and one each with hypopharyngeal and laryngeal carcinoma, who underwent radiotherapy (RT) for head and neck cancer at the Asan Medical Center from March to December 2008 were prospectively included in this study. Patients who showed severe RID (more than wet desquamation) on the supraclavicular fossa or neck areas were treated by wound cleaning and debridement of granulation tissue, followed by daily rhEGF spray and foam dressing. Median time to stop exudates and reepithelialisation was 4 days. Within 14 days (median 8 days), all patients showed complete healing of RID and no longer required dressings. This new method of treatment with dressing containing rhEGF may have the potential to accelerate the healing process in patients with RID. A case-control study is needed to confirm this finding.
    International Wound Journal 06/2014; · 1.60 Impact Factor
  • Joon Pio Hong
    Journal of Reconstructive Microsurgery 05/2014; · 1.00 Impact Factor
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    ABSTRACT: The aim for microsurgical reconstruction has broadened from achieving functional to also providing good esthetic outcomes. The perforator flaps are widely used for this goal. However, perforator flaps can still be bulky especially to resurface the skin defect. We hypothesized that elevation from the superficial fascial plane can obtain a thin and viable flap. In this retrospective study, we report consecutive perforator flaps elevated at the superficial fascial plane from November 2007 to July 2013. Total of 304 flaps which were 196 superficial circumflex iliac perforator (SCIP) flaps, 81 anterolateral thigh (ALT) flaps, and 27 gluteal artery perforator (GAP) flaps were reviewed. The patient group composed of 189 male and 115 female patients with an average age of 35.8 years. The average body mass index was 23.5 kg/m2 (range, 15.91-34.57 kg/m2). All 304 flaps were successfully elevated with this approach with at least one viable perforator. The thickness averaged approximately 6 mm for ALT flap (range, 4-11 mm), 5 mm for SCIP flap (range, 3-12 mm), and 8.5 mm for GAP flap (range, 5-11 mm). Complete survival was noted in 282 flaps, partial loss of flaps requiring secondary procedures in 6 cases, partial loss healing secondarily in 8 cases, and total loss in 9 cases. During the average follow-up of 34 months, secondary debulking procedures were required in six flaps. This new approach of elevation on the superficial fascia is reliable, provides a viable tissue, and is able to obtain a thin flap achieving good functional and esthetic outcome.
    Journal of Reconstructive Microsurgery 02/2014; · 1.00 Impact Factor
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    ABSTRACT: The purpose of this study is to evaluate the clinical application of the GAP free flap harvested above the superficial fascia, as a new approach to reconstruct the soft-tissue defects of the posterior aspect of the lower limb. Between September of 2010 and August of 2013, 27 thin GAP free flaps were used to reconstruct the defects of the posterior aspect of the lower extremity in 27 patients. The defects were distributed on the hindfoot (13 cases), the lower third of the leg (10 cases), mid third of the leg (1case), and thigh (3 cases). All flaps were elevated on the superficial fascia plane and based on a single perforator either from superior or inferior gluteal artery. With exception of 2 flaps which healed secondarily after partial loss, all flaps survived completely. The average thickness of the flap was 8.5 mm.(range: 5 to 11 mm.). The average size of the GAP flap was 125 cm (range: 9 × 4 cm to 25 × 12 cm). The average length of the pedicle was 5.5 cm.(range: 3 to 8 cm.). The average diameter of the artery was 0.65 mm. (range: 0.4 to 1.3 mm.). During the average follow-up of 13 months (rage:2 to 35 months), all flaps showed good contour and did not require any secondary revisions. A free style approach was used to elevate a flap from the gluteal region above the superficial fascia based on a single perforator. This approach can provide a thin flap to achieve ideal contour, does not have to change the position of the patient during the operation minimizing operative risks involved, and the donor site concealed with minimal morbidity. However, the pedicle can be short and sometimes supermicrosurgery skills such as perforator to perforator may be needed to accommodate the short pedicle. Overall, this new approach of using a thin GAP free flap to reconstruct the posterior aspect of the leg and foot can be considered as a feasible option.
    Plastic and reconstructive surgery 01/2014; · 2.74 Impact Factor
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    ABSTRACT: Ambiguous defects on the hand and foot, especially on the fingers and toes, are still challenging to treat despite achievements in reconstruction. The purpose of this study was to evaluate the use of the posterior interosseous artery perforator flap for resurfacing intermediate-sized defects and provide adequate coverage over tendons and bones. Between October 2008 and March 2013, a total of 19 patients with soft-tissue defects on the hand or foot were treated. Flap elevation, anatomy, and clinical progress were evaluated. All flaps survived and covered the defects, which ranged in area from 12 to 45 cm2. The freestyle approach was used to harvest the flaps. The average length of the pedicle was 2.5 cm, and the pedicle was harvested without affecting the source vessel. The average diameter of the artery was 0.8 mm, and the average thickness of the flap was 3.5 mm. Anastomosis was performed either end-to-end on the perforator, or end-to-side on deep vessels. No subsequent thinning or surgical flap correction was necessary. Ambulation was allowed at 3 days postsurgery. The donor site was closed primarily to leave an acceptable donor site. A posterior interosseous artery perforator-free flap is a suitable choice for intermediate-size defects that are too large to cover using a local flap or too small for a first-line perforator flap. Up to 45 cm2 of adequate coverage can be provided using a thin posterior interosseous artery perforator-free flap that does not require additional debulking. The disadvantages of a short pedicle can be overcome using perforator-to-perforator supermicrosurgery.
    Journal of Plastic Reconstructive & Aesthetic Surgery 01/2014; · 1.44 Impact Factor
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    ABSTRACT: Oropharyngeal defects left after tumor resection are usually reconstructed with radial forearm or anterolateral thigh (ALT) perforator free flaps, but these flaps can be too thin or too thick. In this study, medial sural perforator free flaps with intermediate volumes were used for oropharyngeal reconstruction. Of the 243 patients with oropharyngeal cancer who underwent head and neck reconstruction between October 2006 and October 2011, the medial sural perforator free flap was used 20 times. The number and locations of the main sizable perforators, the dimensions and thickness of the flap, and the length of the pedicle were recorded. Satisfactory results were achieved in 18 patients. The flaps in the two remaining cases failed. The vertical locations of the main sizable medial sural perforators were 6 to 15 cm away from the popliteal crease. The medial sural perforator free flaps ranged from 4 to 10 mm in thickness. Medial sural perforator free flaps may be an alternative for medium-sized defects that cannot be properly reconstructed with radial forearm or ALT perforator free flaps because of their inappropriate flap volume.
    Journal of Reconstructive Microsurgery 04/2013; · 1.00 Impact Factor
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    ABSTRACT: When fasciocutaneous flaps are transplanted into the oral cavity, their gross appearance often starts to resemble the intraoral mucosa. The purposes of this study were to analyze the histologic and morphological changes of the fasciocutaneous free flap after its transfer for oropharyngeal reconstruction and to determine the causes of the changes. The study was performed between January 2006 and February 2010 and involved 67 of 239 patients who had undergone reconstructive surgery after oropharyngeal tumor resection. Twenty patients also provided biopsy specimens, which were subjected to histologic evaluation. The correlations between the morphological changes and various factors were analyzed. Histologic analysis revealed that numerous histologic changes occurred, although the overall structure of the skin was maintained. Analysis of the associated factors showed that the primary defect site correlated highly with the morphological changes of the intraoral flaps.
    Annals of plastic surgery 12/2012; · 1.29 Impact Factor
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    ABSTRACT: The superficial circumflex iliac artery perforator (SCIP) flap is an evolved form of groin flap. It overcomes the inherent disadvantages of groin flap by preserving the deep fascia but still requires challenging skills because of short pedicles and small caliber of vessels. The use of SCIP flap was evaluated for lower extremity use.From June of 2009 to August of 2011, a total of 79 cases were performed (age range, 4-80 years) on the lower extremity using supermicrosurgical approach. All flaps were harvested above the deep fat and the pedicles were taken above or just below the deep fascia to reconstruct the defects throughout the lower extremity.Supermicrosurgery technique was used in 71 cases. A total of 75 cases were performed successfully; 1 case underwent revision but failed and 2 cases were lost within 2 days of surgery. Average size of the flap was 75.5 cm, thickness 7 mm, average length of pedicle was 5 cm, and the average caliber of artery was 0.7 mm. Donor sites were all closed primarily but complications were noted with 1 dehiscence and prolong drainage of lymphatics. Flaps provided good functional coverage and appearance. The average follow-up was 12 months.With the modification of elevating the flap on the superficial fascia, we can harvest a thin flap without additional debulking and avoid complications such as lymphorrhea. Furthermore, with the perforator to perforator or perforator to small distal vessel approach, we can apply this flap on all regions of the lower extremity overcoming the difficulties with short pedicle and small vessel caliber. In our hands, the modified SCIP flap is the flap of choice for small to moderate size defects in the lower extremity.
    Annals of plastic surgery 11/2012; · 1.29 Impact Factor
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    ABSTRACT: OBJECTIVE: The traditional unilateral or bilateral buccogingival or bicoronal approach often seems to impose limitations on achieving complete resection and reconstruction of the extensive midfacial fibrous dysplasia. Therefore, we hypothesized that the midfacial degloving approach could be used for the correction of maxillary fibrous dysplasia, which has been primarily used for paranasal sinus lesions or nasopharyngeal tumor. METHODS: The study involved 5 maxillofacial fibrous dysplasia patients who underwent a midfacial degloving surgical procedure. There were 4 male patients and 1 female patient with a mean age of 16.8 years. The average, mean follow-up duration was 17.8 months. A wide, subperiosteal dissection was made along the anterior wall of the maxilla and pyriform aperture over the level of the infraorbital foramen. A bilateral, circumferential, nasal vestibular incision and dissection allowed for bilateral degloving of the middle third of the face over the infraorbital rim. Then total or subtotal resection, followed by reconstruction using an iliac bone graft, was performed. RESULTS: The midface, degloving approach provided visualization of the medial maxillary wall, the pterygoid junction, nasofrontal suture, infraorbital rim, and laterally to the temporal process of the zygoma. Subtotal or total resection of the lesions and reconstruction with bone grafts was possible in all 5 patients, and there were no complications. There was also no visible facial scarring and all patients expressed satisfaction with the cosmetic outcome. CONCLUSIONS: The midfacial, degloving approach was found to be safe and effective for maxillofacial fibrous dysplasia, and nearly total resection was possible. This approach allows for a wider dissection and resection compared with the traditional buccogingival approaches, and there was no visible facial scarring.
    The Journal of craniofacial surgery 11/2012; · 0.81 Impact Factor
  • Tae Suk Oh, Ho Seung Lee, Joon Pio Hong
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    ABSTRACT: The purpose of this study was to evaluate the outcome of the diabetic foot reconstructed with free flaps and analyse the preoperative risk factors. This study reviews 121 cases of reconstructed diabetic foot in 113 patients over 9 years (average follow-up of 53.2 months). Patients' age ranged from 26 to 78 years (average, 54.6 years). Free flaps used were anterolateral thigh (ALT, 90), superficial circumflex iliac artery perforator (SCIP, 20), anteromedial thigh (AMT, 5), upper medial thigh (UMT, 3), and other perforator free flaps (3). Correlation between the surgical outcome and preoperative risk factors were analysed using logistic regression model. Total loss was seen in 10 cases and 111 free-tissue transfers were successful (flap survival rate of 91.7%). During follow-up, limb was eventually lost in 17 patients and overall limb salvage rate was 84.9% and the 5-year survival was 86.8%. Correlation between flap loss and 14 preoperative risk factors (computed tomography (CT) angiogram showing intact numbers of major vessels, history of previous angioplasty, peripheral arterial disease (PAD), heart problem, chronic renal failure (CRF), American Society of Anaesthesiologists (ASA) physical status classification system, smoking, body mass index (BMI), HBA1c, lymphocyte count, ankle-brachial index (ABI), osteomyelitis, C-reactive protein (CRP) level and whether taking immunosuppressive agents) were analysed. Significant odds ratio were seen in patients who underwent lower extremity angioplasties (odds ratio: 17.590, p < 0.001), with PAD (odds ratio: 10.212, p = 0.032) and taking immunosuppressive agents after kidney transplantation (odds ratio: 4.857, p < 0.041). Diabetic foot reconstruction using free flaps has a high chance for success and significantly increases the 5-year survival rate. Risk factors such as PAD, history of angioplasties in the extremity and using immunosuppressive agents after transplant may increase the chance for flap loss.
    Journal of Plastic Reconstructive & Aesthetic Surgery 10/2012; · 1.44 Impact Factor
  • Joon Pio Hong, Sung Woo Park
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    ABSTRACT: Diabetic wound is a chronic wound in which normal process of wound healing is interrupted. Such as lack of blood supply, infection and lack of functional growth factors are assumed as one of the many conditions which lead to non healing environment. Epidermal growth factor (EGF) acts primarily to stimulate epithelial cell growth across wound. Erythropoietin (EPO) is a haematopoietic factor, which stimulates the production, differentiation and maturation of erythroid precursor cells. This study hypothesised combining these two factors, non healing process of diabetic wound will be compensated and eventually lead to acceleration of wound healing compared to single growth factor treatment. A total of 30 diabetic Sprague-Dawley rats were divided into three treatment groups, (single treatment of rh-EPO or rh-EGF, or combined treatment on a full-thickness skin wound). To assess the wound healing effects of the components, the wound size and the healing time were measured in each treatment groups. The skin histology was examined by light microscopy and immunohistochemical analysis of proliferating markers was performed. The combined treatment with rh-EPO and rh-EGF improved full-thickness wound significantly (P < 0·05) accelerating 50% healing time with higher expression of Ki-67 compared to single growth factor treated groups. The combination treatment filed to accelerate the total healing time when compared to single growth factor treatments. However, the significant improvement were found in wound size reduction in the combined treatment group on day 4 against single treated groups (P < 0·05). This study demonstrated that the combined treatment of rh-EPO and rh-EGF improved the wound healing possibly through a synergistic action of each growth factor. This application provides further insights to combined growth factor therapy on non healing diabetic wounds.
    International Wound Journal 10/2012; · 1.60 Impact Factor
  • Joon Pio Hong, In Wook Chung
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    ABSTRACT: The elevation plane for the anterolateral thigh perforator flap is either subfascial or suprafascial approach. But extensive debulking is frequently performed with possibilities of endangering viability. We hypothesized that by elevating the flap in the layer between the deep and the superficial fat, the superficial fascia, we will be able to achieve elevation of a thin and hemodynamically reliable flap without wasting human tissue. This approach was performed on 54 cases. The average weight was 68.1 kg, and average body mass index was 24.6 kg/m. Primary closure was performed on 18 cases and skin grafts on 36 cases. Evaluation for flap survival, contour of the flap, and donor site were performed. All 54 flaps were successfully elevated with at least one viable perforator with this approach. Total flap loss was noted in 1 case, resulting in a 98% survival rate. Secondary debulking was performed on 3 cases whose body mass index was >29. Regarding donor site, the primarily closed sites showed no complications, and the grafted skin over the deep fat leads to similar contour compared with the contralateral side. The study shows that this new plane can be used as a level of elevation while acting as a guide to promise adequate blood supply based on the subdermal plexus.
    Annals of plastic surgery 10/2012; · 1.29 Impact Factor
  • Joon Pio Hong, Tae Suk Oh
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    ABSTRACT: The treatment of diabetic foot ulceration is complex with multiple considerations often leading to limb amputation. This article presents the usefulness of a multidisciplinary approach along with an algorithm to manage and salvage diabetic foot ulcers from amputation. This algorithm is a step-by-step guide to manage the diabetic foot ulcer and can help one in the selection of patients for limb salvage reconstruction.
    Clinics in plastic surgery 07/2012; 39(3):341-52. · 0.95 Impact Factor
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    ABSTRACT: Pediatric reconstruction using microsurgery is accepted normal practice, and the use of perforator flaps is slowly increasing. This study presents clinical work using various perforator free flaps by free style approach to reconstruct lower extremity soft tissue defects in pediatric patients and evaluates its efficacy. Between June 2002 and February 2011, 32 cases (mean age: 10.1 years) were reconstructed with free style perforator free flaps. Retrospective evaluations for flap survival, growth character, and other associated morbidities were performed. Flaps used in this series are anterolateral thigh (ALT) perforator, superficial circumflex iliac artery perforator (SCIP), upper medial thigh perforator, and posterior interosseous perforator free flaps. The free style approach for pedicle dissection was successful in all cases. Early postoperative complications were 15.6% from hematoma collection to partial loss of flap. Although there was no total loss in this series, one case needed additional flap coverage to cover the partial loss of the flap. The long-term follow-up showed contracture along the margin, with 16% needing a releasing procedure. Bone growth was not affected by flap contracture. The overall results show perforator flaps using the free style approach to be a reliable and feasible approach for lower extremity reconstruction in the pediatric population.
    Journal of Reconstructive Microsurgery 06/2012; 28(9):589-94. · 1.00 Impact Factor
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    ABSTRACT: Alcohol is not used directly to the vascular lesion without mixing with the contrast agent because alcohol itself cannot be seen on the fluoroscopy. Since we have used alcohol for the venous malformations in the head and neck area, we realized that alcohol can be safely and effectively used without using fluoroscopy. We present the method of direct sclerotherapy using absolute alcohol without using fluoroscopy. After obtaining and carefully analyzing direct puncture venogram, we used this technique in 22 patients who underwent alcohol sclerotherapy. Because fluoroscopy was not used during alcohol injection, the angiotable can be placed outside of C-arm so that alcohol was comfortably injected without any obstacle around the patients. Venogram can also be obtained between the injections to detect whether there is any dangerous venous outflow drainage such as the superior ophthalmic vein to the cavernous sinus. To control the venous outflow, local compression to the draining vein was applied. The result and complication such as skin necrosis, infection, and nerve injury were evaluated during mean follow-up period of 13 months (range, 1-63 months). The frequency of sclerotherapy was one in 16 and 2-5 in 6 patients. The volume of alcohol used per treatment session ranged from 2 to 18 mL (mean, 8.5 mL). There was the minimum change in 1 (4.5%), moderately decreased lesion in 12 (54.5%), and markedly decreased lesion in 9 (41%) patients. The patients did not reveal any complications during 12.9 months follow-up period. Direct puncture alcohol sclerotherapy without using fluoroscopy can be a safe and effective technique for treating venous malformation of the head and neck areas. In addition, the procedure can be performed in the comfortable position because biplane fluoroscopy would not be necessary.
    Neurointervention. 08/2011; 6(2):84-8.
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    ABSTRACT: Among hundreds of pathophysiologic factors that impair healing of the diabetic foot, diminished perfusion and neovascularization are critical. This study aimed to show the effect of human adipose-derived stem cells on healing of ischemic wounds in diabetic nude mice and thus to estimate the possibilities of adipose-derived stem cells for diabetic wound care. Sixty nude mice were assigned randomly into group Ia (diabetic control, n = 20), group Ib (diabetic experimental, n = 20), or group II (nondiabetic control, n = 20). After creation of an ischemic limb, human adipose-derived stem cells were injected locally. Gross and histologic observations were made after 3, 7, and 25 days, and plasma and tissue levels of vascular endothelial growth factor were quantified. Group Ia animals typically showed gangrene formation with a delayed and sustained inflammatory reaction, which led to a high rate of autoamputation and a lower survival rate. Group Ib animals had a tendency for earlier and abundant neovessel formation and better tissue remodeling rather than fibrotic cicatrization, resulting in lower rate of autoamputation and a survival rate comparable to group II. Surviving stem cells were identified at day 25, but no specific differentiation was observed. Plasma and tissue vascular endothelial growth factor level in group Ib was higher than in group Ia and comparable to that in group II. This study demonstrated the beneficial effect of human adipose-derived stem cells on healing of ischemic wound in diabetic nude mice. Elevation of vascular endothelial growth factor levels in plasma and tissue suggests the importance of secretory factor, which regulates local angiogenesis and triggers a systemic response.
    Plastic and reconstructive surgery 08/2011; 128(2):387-94. · 2.74 Impact Factor
  • Tae Suk Oh, Geoffrey Hallock, Joon Pio Hong
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    ABSTRACT: The reconstruction of complex defects of the back remains difficult. However, a local skin flap alone based on a competent single perforator can have a large skin territory with an efficient arc of rotation as a propeller flap to cover many back wounds, while the donor site can still be closed primarily. Eleven patients with defect sizes ranging from 36 to 264 cm(2) underwent coverage of posterior trunk defects using propeller flap (rotated perforator flaps), and all the donor sites were primarily closed. The average number of perforators within the flap was 1.4. All flaps healed uneventfully except for 1 case in which congestion was noted; leech was applied and the flap healed well. Radiation therapy was done in 1 case and was uneventful. The freestyle perforator propeller flap can be a reliable and a simpler solution to reconstruct a difficult defect while achieving minimal donor site morbidity.
    Annals of plastic surgery 05/2011; 68(1):79-82. · 1.29 Impact Factor

Publication Stats

391 Citations
116.94 Total Impact Points

Institutions

  • 2003–2014
    • University of Ulsan
      • • Asan Medical Center
      • • College of Medicine
      Urusan, Ulsan, South Korea
    • Ulsan University Hospital
      Urusan, Ulsan, South Korea
  • 2003–2012
    • Asan Medical Center
      • • Department of Plastic Surgery
      • • Department of Radiation Oncology
      Seoul, Seoul, South Korea
  • 2010
    • Yonsei University Hospital
      • Department of Internal Medicine
      Sŏul, Seoul, South Korea
  • 2002
    • Yonsei University
      • Department of Plastic & Reconstructive Surgery
      Seoul, Seoul, South Korea
    • Wonju Severance Christian Hospital
      Genshū, Gangwon, South Korea