Kyeong-tae Lee

• MD, PhD
• Professor (Associate) at Samsung Medical Center

Background: The authors performed a comprehensive literature review regarding functional impairment after latissimus dorsi muscle transfer, to investigate functional changes in the donor site and the potential impact on patients' daily lives. Methods: The PubMed database was searched for articles regarding functional donor-site morbidity followi...

Background: Immediate breast reconstruction is safe from an oncological perspective, but the relatively high rate of postoperative complications raises oncological concerns. The present study aimed to evaluate the potential influence of postoperative complications after immediate breast reconstruction on breast cancer recurrence and survival. Met...

Importance: The potential association between breast implant-related anaplastic large cell lymphoma (BIA-ALCL) and implant texture has raised concerns about the additional unexpected adverse effects of textured implants, including potentially adverse outcomes for other cancers. In addition to the risk of developing BIA-ALCL, breast cancer survivors...

Importance Meticulous postoperative flap monitoring is essential for preventing flap failure and achieving optimal results in free flap operations, for which physical examination has remained the criterion standard. Despite the high reliability of physical examination, the requirement of excessive use of clinician time has been considered a main dr...

Background With an increasing need for thin flap, the use of super-thin anterolateral thigh (ALT) flaps, raised above the supra-superficial fascia, has drawn great attention. Controversy remains regarding whether such thin flap elevation could affect postoperative outcomes, encompassing perfusion-related complications (PRC) and donor morbidities. T...

Reducing donor‐site morbidity is crucial in free‐flap reconstruction, with the primary goals of achieving dermis‐to‐dermis closure and avoiding skin grafts. Although latissimus dorsi (LD) myocutaneous and thoracodorsal artery perforator (TDAP) flaps usually allow primary closure, larger flap harvests may require skin grafts, potentially leading to...

In the realm of implant-based breast reconstruction, mastectomy flap necrosis (MFN) is a prevalent yet grave complication that poses a threat to the stability of the inserted prosthesis. Although numerous investigations have scrutinized the risk factors for MFN development, few have delved into the aftermath, specifically implant failure or salvage...

Background Despite the recent steep rise in the use of prepectoral direct-to-implant (DTI) breast reconstruction, concerns remain regarding the potentially risk of complications, resulting in the selective application of the technique; however, the selection process was empirically based on the operator's decision. Using patient and operation-relat...

In the development of plantar melanoma, it is suspected that mechanical stress caused by weight-bearing activities, such as walking, rather than ultraviolet exposure, may play a significant role, showing a concentrated prevalence in areas of the foot where weight-bearing actions are prevalent. However, research investigating whether such mechanical...

The widely used triple-antibiotics irrigation solution, comprising cefazolin, gentamycin, and povidone-iodine solution, has been employed for preventing infection and capsular contracture in implant-based breast reconstruction. However, potential overlapping in the coverage of such antimicrobial effects and the recent emergence of cefazolin-resista...

Purpose Recent trends in reconstructive surgery focus on rapid recovery, questioning the necessity of postoperative drains. Although harvesting perforator flaps causes minimal injury to anatomical structures at donor sites, attempts to omit drains have been limited. This study aimed to assess the safety of not using drains after harvesting the ante...

BACKGROUND Conjoined bilateral deep inferior epigastric perforator (DIEP) flap with intraflap anastomosis is an efficient approach for breast reconstruction, enabling the use of almost the entire abdominal tissue. Variations in bilateral DIEA anatomy may make it challenging to apply this technique consistently. This study aimed to derive optimal st...

The internal mammary artery perforator (IMAP) flap has been widely used for chest wall and neck reconstruction. The color of its skin paddle closely resembles that of facial skin, making it attractive for facial reconstruction. However, there has been insufficient investigations reporting the use of free IMAP flap. Furthermore, even in such studies...

A 47-year-old male patient presented with multiple squamous and basal cell carcinomas on the anterior chest, back, and left cheek. The patient experienced odorous discharge from the tumors. Surgical excision was planned, beginning with the anterior chest squamous cell carcinoma. An extensive 32×30 cm cutaneous defect was created, which was covered...

Purpose: Neoadjuvant chemotherapy (NACT) followed by total mastectomy and immediate reconstruction has become an important strategy in the treatment of breast cancer. Although the safety of subpectoral implant-based breast reconstruction with NACT has been extensively evaluated, the safety in prepectoral reconstruction has not been clearly elucida...

Recently, the pathomechanisms of keloids have been extensively researched using transcriptomic analysis, but most studies did not consider the activity of keloids. We aimed to profile the transcriptomics of keloids according to their clinical activity and location within the keloid lesion, compared with normal and mature scars. Tissue samples were...

Background Reconstruction of forefoot defects often necessitates free tissue transfer due to the limited availability of local tissue. Microsurgical reconstruction of the forefoot remains challenging as it requires durable yet thin, soft tissue coverage for functional restoration. This study aimed to evaluate the efficacy of free thin perforator fl...

Background With the growing demand for the use of thin perforator flaps, obtaining knowledge on the superficial anatomy of perforators is imperative for stable flap elevation. Conventional modalities for perforator mapping fall short in providing such information. High‐frequency ultrasound (HFUS), known for visualizing the superficially located ana...

Background Extensive experimental evidence has suggested the potential efficacy of prostaglandin E1 (PGE1) in enhancing flap survival, leading to its widespread empirical use following free flap operation. However, the translation of these experimental findings into clinical benefits remains uncertain. This study aimed to assess the clinical effect...

Background Free tissue transfer is often required for the reconstruction of complex and deep anterior chest wall wounds, for which the identification of suitable recipient vessels is crucial. Although the internal mammary arteries (IMAs) are a representative option, identifying secondary options when these vessels are compromised remains a challeng...

Background Mast cells (MCs) and neural cells (NCs) are important in a keloid microenvironment. They might contribute to fibrosis and pain sensation within the keloid. However, their involvement in pathological excessive scarring has not been adequately explored. Objectives To elucidate roles of MCs and NCs in keloid pathogenesis and their correlat...

Background When choosing a method of deep inferior epigastric perforator (DIEP) flap for breast reconstruction, concerns regarding the potentially detrimental effects of obesity on postoperative recovery remain. Enhanced recovery after surgery (ERAS) is known to facilitate rapid postoperative recovery. This study aimed to examine the effect of the...

In free flap operation, temporary hyperemia of the transferred flaps can often be encountered in the early postoperative period, appearing reddish and rapid capillary refilling time, which mimics venous congestion. This study aimed to investigate the factors associated with the development of hyperemia and evaluate clinical course. Consecutive pati...

Purpose: Despite the increasing use of immediate breast reconstruction (IBR), its oncologic safety in the setting of neoadjuvant chemotherapy (NACT) needs to be comprehensively clarified in breast cancer management. The objective of the present study was to analyze the oncologic safety of IBR following NACT. Methods: In total, 587 patients with...

Purpose: Ablation of malignant neoplasms of the scalp usually leaves extensive defects. Free musculocutaneous transfer using the latissimus dorsi muscle with a skin graft has been the gold standard for restoring such defects; however, this approach may be limited by potential functional morbidity and delayed healing of the grafted skin. This study...

Wide local excision of noninvasive malignant melanomas has been increasingly performed instead of digit amputation, which often results in extensive fingertip defects. Owing to the unique anatomical characteristics of the fingertips, achieving favorable outcomes in both function and cosmesis is challenging during reconstruction. The free superficia...

Background: Excision of sacral tumor results in extensive defects and vital organ exposure, requiring soft tissue reconstruction for dead space obliteration. Diverse reconstruction options, mainly regional flaps, have been utilized but are limited by high postoperative morbidity. A reliable reconstructive method with low morbidity and facilitated...

Wide local excision remains the main treatment modality for primary lip cancer, which often results in considerable deficits of lip tissue and requires reconstruction using free tissue transfer. Although diverse free flaps, such as radial forearm flap or anterolateral thigh flap, have been used, their application is often limited by their inherent...

Background: Donor site defects following the radial forearm flap (RFF) harvest have been usually covered with skin grafting, which often lead to suboptimal outcomes and donor morbidities, including delayed healing and scar contractures. The present report aimed to evaluate the outcomes of using another free flap, the domino flap, for coverage of d...

Choosing reliable recipient vessels is crucial for successful free flap reconstruction of lower extremity defects, especially in patients with ischemic vasculopathy. This report describes our experience with the intraoperative use of indocyanine green angiography (ICGA) for selecting recipient vessels in lower extremity free flap reconstruction cas...

Background: For free-flap monitoring, physical examination still serves as the criterion standard. Blood glucose measurement (BGM) has been suggested to be useful in identifying flap perfusion status. Nonetheless, its routine use may not be cost-effective in real-world settings. This study aimed to share the experiences of using BGM for flap monit...

Background: In two-stage expander-based breast reconstruction, the use of air as the initial filling medium has been suggested to confer clinical advantages over conventional saline, but this has not been demonstrated in a large series. The present study aimed to evaluate the association between material type (air versus saline) for initial expand...

Background Although drainless donor closure with progressive tension suture (PTS) technique has been attempted to further reduce donor morbidity in deep inferior epigastric perforator (DIEP) flap-based breast reconstruction, its clinical safety has not yet been fully elucidated. This study prospectively investigated donor morbidity after DIEP flap...

Purpose Despite the increasing popularity of free tissue transfer, thigh defects have been alienated from their potential indication, owing to the abundance of regional reconstruction options. However, some challenging situations where locoregional modalities may lead to suboptimal outcomes often require free flap. Due to lacking studies regarding...

Two-stage tissue expander/implant (TE/I) and deep inferior epigastric perforator (DIEP) flaps are the two main pillars of breast reconstruction. This study aimed to conduct a longitudinal analysis of long-term outcomes after immediate DIEP- and TE/I-based reconstruction. This retrospective cohort study included patients with breast cancer who under...

Background: Despite several technical modifications to further reduce donor invasiveness in harvesting deep inferior epigastric perforator (DIEP) flaps, techniques with general applicability and demonstrating clinical benefits are scarce. The present study aimed to introduce a short-fasciotomy technique and evaluate its reliability, efficacy, and...

Background: Fat necrosis, often developing following deep inferior epigastric perforator (DIEP) flap-based breast reconstruction, is not a negligible complication. This study aimed to conduct a longitudinal assessment of the clinical course of fat necrosis in breast reconstruction with DIEP flap. Methods: Among patients undergoing immediate DIEP...

Background: Although a dual-innervation technique has emerged in single-stage functional latissimus dorsi (LD) muscle transfer for smile reanimation, its benefits over conventional techniques have not been elucidated. Objective: To compare outcomes of dual-innervation technique with those of single-innervation. Methods: Patients with facial palsy t...

Background: Whether the breast reconstruction modality could influence the long-term development of post-mastectomy lymphedema has been little investigated. The present study aimed to evaluate the potential association of the breast reconstruction method with the incidence of lymphedema over an extended follow-up period. Methods: Patients with b...

Background Flap congestion related with venous thrombosis is a major cause for microsurgical lower extremity reconstruction failure. Conducting dual venous anastomosis has been suggested to reduce risks for the adverse outcomes; however, its efficacy remains controversial. This study evaluated a potential association of dual venous anastomosis with...

Purpose: In two-stage prosthetic breast reconstruction, autologous fat graft (AFG) is often conducted simultaneously with the second-stage operation, which is usually performed shortly after mastectomy. There is a paucity of studies evaluating whether conducting AFG early, with a relatively short interval from the primary operation, is oncological...

Purpose: Wide excision and subsequent reconstruction of the defect are crucial pillars in the treatment of soft tissue sarcoma (STS); however, those procedures carry a relatively high risk of postoperative complications, which could raise oncologic concerns. The present study evaluated the association of postoperative complications after resection...

Background: Reconstruction of penoscrotal defects resulted from margin-controlled excision of extramammary Paget's disease (EMPD) remains challenging, due to its unpredictably varying extents. The present study aimed to investigate outcomes of reconstruction of penoscrotal defects following radical excision of EMPD and to introduce a simplified al...

Background: The latissimus dorsi (LD) muscle originates from the lower thoracic spine with broad attachment and plays a subsidiary role in spinal postural stability. We investigated whether harvesting unilateral LD muscle for breast reconstruction could influence spinal posture in the long-term. Methods: Patients who underwent immediate unilater...

Background: The paucity of reliable recipient vessels adjacent to defects poses a great challenge in free flap reconstruction. Although the use of interposition vein grafts to cover the vascular gap is common, its potential association with higher risks of flap compromise is often reported. Interposition arteriovenous bundle grafts have been intro...

Background: Sarcopenia, defined as a significant loss of skeletal muscle mass and function, is suggested to be associated with an increased risk of complications after various surgical interventions. However, evidence regarding sarcopenia in microsurgical breast reconstruction has been lacking. The present study was designed to evaluate the associ...

Background: Despite the long-standing presumption that nighttime surgery could affect adverse outcomes, its association independent of patient's general condition and disease severity remains unclear. We hypothesized that conducting elective surgery for subjects with good physical status at nighttime was not associated with increased risks of post...

Background: Reconstruction of congenital microtia remains challenging, particularly in patients with a history of ear canaloplasty due to insufficient regional soft tissue. The insertion of a tissue expander prior to implantation of the cartilage framework has traditionally been employed. However, this procedure could induce additional morbidity....

Background: Primary defatting is suggested as an effective and appealing technique for achieving flap thinning. There has been a long-standing concern regarding its potential adverse effects on flap perfusion, for which limited clinical evidence exists. This study aimed to investigate whether primary defatting negatively influences the outcomes of...

Background Two-stage tissue expander/implant-based method has been used predominantly for breast reconstruction. Implant rupture is one of the bothersome complications, inducing additional morbidity including reoperation. The present study aimed to identify the independent factors associated with development of implant rupture. Patients and Methods...

Background: Since April 2015, the Korean National Health Insurance (NHI) has reimbursed breast cancer patients, approximately 50% of the cost of the breast reconstruction (BR) procedure. We aimed to investigate NHI reimbursement policy influence on the rate of immediate BR (IBR) following total mastectomy (TM). Methods: We retrospectively analyz...

One-stage latissimus dorsi neuromuscular transfer has distinct advantages and has become a viable option for dynamic smile reconstruction. A dual-innervation technique has emerged that supplies the transferred latissimus dorsi muscle with two neural inputs, the ipsilateral masseteric nerve and the contralateral facial nerve branch. This technique h...

Facial paralysis is often accompanied by contour deformity. Reconstruction of this complex facial paralysis presents a challenge to reconstructive surgeons. Simultaneous reconstruction of established facial paralysis and concomitant contour deformity may require two flap components: a functional muscle flap for dynamic smile reconstruction and a va...

In Reply We deeply appreciate valuable comments provided by de Andrade Urban et al, Bijlard and Mureau, and Maarse and Teunis in response to our study.¹ Thankfully, they addressed several critical points that had not been fully considered during preparation of our original study.

Purpose: In this study, we examined the impact of reconstruction using tissue expander insertion (TEI) on the risk of radiation dermatitis in patients undergoing postmastectomy radiotherapy (PMRT). Methods: Between August 2015 and March 2019, patients with breast cancer who had received systemic chemotherapy and PMRT were prospectively included....

While free flaps have been widely used for reconstruction of pretibial defects, the extended operation times are known to be a major drawback. This report presents a case of successful lower leg reconstruction for a large pretibial defect with a bone-anchored advancement flap and split-thickness skin graft. A 59-year-old female patient underwent wi...

Background: Free flap operation is a common procedure for reconstructing defects of the lower extremity. However, venous congestion often results in flap failure in lower extremity reconstruction. Dual-vein anastomosis, one proposed solution to overcome this problem, has been controversial in terms of its efficacy. The objective of this study was t...

Background: In two-stage prosthetic breast reconstruction, two types of tissue expanders are used for the first stage: microtextured Siltex and macrotextured Biocell. Despite emerging concerns regarding the safety of macrotextured prostheses, the association between the use of macrotextured expanders and adverse outcomes remains unknown clinically...

Reconstruction following wide excision of perianal lesion is challenging as it requires resistance to high risks of wound contamination and preservation of anal function. Here, we present a case of a unilateral superior gluteal artery perforator (SGAP) flap with an opening in the flap. A 77-year old woman was referred due to an extramammary Pagets...

Since the introduction of distally based flap, the concept of reverse flow flap was expanded to free tissue transfers. For recipient vessels, retrograde arterial inflow is considered a safe option for anastomosis. However, the reliability of a retrograde recipient vein remains controversial. This report presents a case of successful lower leg recon...

Background: In immediate two-stage implant-based breast reconstruction, adjuvant chemotherapy, when indicated, is usually conducted between the stages, which might influence the outcomes of the second-stage operation. Objective: The purpose of this study was to evaluate the potential influence of adjuvant chemotherapy on the final outcomes of tw...

Background Overweight and obesity are well-known risk factors for postoperative complications; however, their impacts on hematoma formation have not been clarified. Several studies have suggested that overweight/obesity could have procoagulative effects, potentially reducing a risk for developing postoperative bleeding complications. This study aim...

Pedicled anterolateral thigh (ALT) flap has been employed for coverage of low abdominal wall defects. However, its use is limited for defects located more on the cranial side because of insufficient pedicle length. We present a case of successful reconstruction of mid‐abdominal wall defect using pedicled ALT flap, overcoming the issue of pedicle le...

Background Transconjunctival fat repositioning is the gold standard for the correction of tear trough deformity. For fixation of fat pedicle, the internal fixation (IF) and externalized percutaneous suture (EPS) techniques are used, which have their own advantages and disadvantages. The present study aimed to introduce a new IF technique using a de...

Background: Patients with scalp angiosarcoma still present with a dismal prognosis, indicating the need for a multidisciplinary approach. The present study aimed to investigate the treatment outcomes of scalp angiosarcoma with a focus on the effect of radiotherapy and chemotherapy, performed in either an adjuvant or palliative setting, after curat...

Background Prosthetic breast reconstruction has been gaining popularity and a variety of implant options are currently available. Therefore, it is important to evaluate the safety and efficacy of newly developed shaped implants compared with those of conventional round implants. To date, few studies have investigated the outcomes of breast reconstr...

Background : Few studies have evaluated clinical outcomes of novice surgeons trained in a microsurgical training program. Here, we describe successful free flap reconstructions performed by trainees who completed a structured microsurgical training program. Methods : The Microsurgical Skills Training Course, a laboratory-based structured microsurg...

Partial sacrectomy is a common treatment for sacral sarcomas, which often results in a large defect and exposed rectal wall. The defect could be covered using a gluteus maximus (GM) advancement flap. However, seroma and wound dehiscence are often observed after GM advancement flap coverage, delaying the wound healing process. We present a case of b...

Although the success rate of deep inferior epigastric perforator (DIEP) flaps has increased, late flap failures still occur and have a low salvage rate. The present article describes a case of salvage of a case of late flap failure using the pedicle vein as a vein graft source. A 50-year-old woman underwent a bilateral DIEP free flap procedure. On...

Background: This study aimed to assess the extent of rectus muscle damage in deep inferior epigastric perforator (DIEP) flap harvest and to evaluate its association with functional donor morbidity. Methods: A prospective cohort of 76 patients who underwent DIEP flap breast reconstruction was evaluated preoperatively and followed up for 1 year. A...

Background: A somatic mutation of GNAQ (c.548G>A, p.Arg183Gln) plays a key role in capillary malformation development. The present study aimed to evaluate clinical manifestations of port-win stain (PWS) associated with this genetic mutation. Methods: Skin tissue was obtained from 70 patients with capillary malformation who had been treated with...

Background: A closed-suction drain is usually inserted during tissue expander-based breast reconstruction. Prolonged duration of drain retention can disturb patients' daily lives and affect overall sociomedical costs. This study aimed to investigate factors that may influence the drainage and to identify predictors of unusually prolonged drain dur...

Background Angiotensin receptor blocker (ARB), a commonly used antihypertensive drug, is reported to affect wound healing and flap survival in animal models. However, this has not been elucidated in a clinical series. This study aimed to investigate the impact that perioperative use of ARB has on outcomes after breast reconstruction. Methods Patie...

Background: Closed reduction of the fracture under general or local anesthesia with elevators or forceps is widely used to treat nasal bone fractures. However, operating under general anesthesia increases the risk of morbidity and raises the cost of management. Furthermore, using forceps or elevators may cause undercorrection, new fractures, mucos...

Background: Single-stage latissimus dorsi (LD) neuromuscular transfer has been a valuable option for dynamic smile reanimation. However, there is a paucity of studies evaluating the potential donor morbidity in such cases. The present study aimed to comprehensively analyze the donor morbidity following functional LD muscle transfer. Methods: Pat...

Background The aim of this study was to evaluate the impact of breast reconstruction modality on the incidence of shoulder morbidity. Methods Breast cancer patients who underwent immediate reconstructions using three modalities, namely, tissue expander-implant, latissimus dorsi (LD) pedicled flap, and deep inferior epigastric artery perforator (DI...

Background: The present study aimed to evaluate the influence of vertical location and spacing of perforators within flaps on the outcomes of deep inferior epigastric perforator (DIEP) flap breast reconstruction. Methods: Patients who underwent unilateral breast reconstruction with unipedicle DIEP flaps were identified. They were categorized int...

Pedicled perforator flaps (PPFs) have been widely used to treat pressure sores in the gluteal region. Selection of a reliable perforator is crucial for successful surgical treatment of pressure sores using PPFs. In this study, we evaluate the role of magnetic resonance imaging (MRI) in planning PPF reconstruction of pressure sores in the gluteal re...

Background: Nagata's two-stage technique for microtia reconstruction using autologous costal cartilage consists of the implantation of a fabricated cartilage framework and the elevation of the constructed auricle. Achieving long-lasting, sufficient projection of the auricle is a goal of second-stage surgery; however, unfavorable outcomes have been...

Background: Acellular dermal matrix (ADM), popularly used in tissue expander-based breast reconstruction, is applied either as a partial or full sling, but without any consensus regarding which method of application produces better outcomes. We aimed to compare the outcomes between two patient groups who underwent tissue expander-based breast reco...

Background: This study aimed to use a super-thin, free superficial circumflex iliac artery perforator (SCIP) flap in the functional surgery for treating subungual melanoma and to evaluate its outcomes. Methods: Forty-one patients with primary subungual melanoma of ≤ 2-mm thickness who were treated with functional surgery were prospectively enrol...

Purpose: Despite extensive previous investigations regarding the efficacy of lymphaticovenular anastomosis (LVA) for the treatment of lymphedema, few studies have reported the long-term clinical course of individual patients undergoing LVA. The present study presented our experience of LVA and to report serial postoperative courses. Methods: A r...

Background: The current diversity of the available acellular dermal matrix (ADM) materials for implant-based breast reconstruction raises the issue of whether there are any differences in postoperative outcomes according to the kind of ADM used. The present meta-analysis aimed to investigate whether choice of ADM products can affect outcomes. Met...

Background Reconstruction of foot defects following oncologic resection is a crucial element in the treatment of soft tissue malignancy of the foot. Objective The present study aimed to comprehensively evaluate outcomes of oncologic foot reconstruction using free perforator flaps. Methods Outcomes of patients with soft tissue malignancy of the foot...

Background: Despite an expanding role of adjuvant radiotherapy and the popularity of two-stage prosthesis-based reconstruction in the treatment of breast cancer, there is no consensus on the proper timing of postmastectomy radiotherapy (PMRT) in relation to the two stages of the reconstruction procedure. The present meta-analysis investigated the...

Background: A Pfannenstiel incision involves the obstruction of superficial venous pathways and functional diversion of flow through alternative pathways and adjacent vessels. This study investigated the effect of a prior Pfannenstiel incision on venous anatomy of the lower abdominal wall; specifically, the superficial inferior epigastric vein (SI...