Ma Rhip Ahn’s research while affiliated with Catholic University of Korea and other places

Lower extremity reconstruction is challenging because of its intricate anatomy and dynamic biomechanics. Although microsurgical free tissue transfer offers pivotal solutions to limited local tissue availability, vascular pedicle exposure after free tissue transfer is common. We evaluated a novel method of managing pedicle exposure after free tissue transfer using a reprocessed micronized dermal substitute. Ten patients who underwent lower-extremity reconstruction using free tissue transfer and micronized dermal substitute between January and December 2023 were retrospectively reviewed. When native tissue could not be closed over the pedicle, reprocessed micronized artificial dermal matrix (rmADM) was cut and stacked to protect and stabilize it. Epithelialization was achieved by secondary skin grafting or healing by secondary intention. Flap dimensions, recipient artery and vein, ADM size, time required for granulation tissue maturation and complete epithelialization, and flap outcomes were analyzed. The mean age was 55.80 ± 20.70 years, and six patients (60%) were diabetic. The mean rmADM coverage area was 8.70 ± 8.41 cm2, and the average time required for complete epithelialization was 50.89 ± 14.21 days. Except for one total necrosis due to bypass graft failure, nine limbs were successfully salvaged. Application of rmADM offers numerous advantages, including vascular collapse prevention, moisture maintenance, granulation tissue growth promotion, and pedicle stabilization.

Background: Split-thickness skin graft (STSG) is a fundamental and versatile technique used in reconstructive surgery. Despite numerous studies addressing the management of STSG donor sites, there is still little consensus on the optimal dressing method. This study aimed to analyze the effectiveness of a novel method that combines a fenestrated polyurethane film with negative-pressure wound therapy (NPWT) over conventional moist dressings.Methods: Between January 2021 and December 2022, 23 patients who received STSG were retrospectively reviewed. In group A, a polyurethane film punctured with a 20-gauge needle was applied to the skin graft donor site. A NPWT system (CuraSys) was subsequently applied over the film. The conventional NPWT was replaced with a portable NPWT (PICO system) on the day of discharge. On the 14th postoperative day, the NPWT and film were removed. In group B, patients were administered a traditional moist dressing until epithelization. Postoperative pain, reepithelization rate, and dressing cost per cm² were compared.Results: Group A exhibited a lower mean pain score on all the measured days. Furthermore, group A demonstrated a significantly shorter time required for complete reepithelization (18.07±8.43 days vs. 28.20±5.25 days, P=0.003) and a lower dressing cost per square centimeter (6,517±6,162 KRW [4.82±4.56 USD] vs. 23,036±27,157 KRW [17.05±20.11 USD], P=0.006).Conclusion: The combination of fenestrated polyurethane film and NPWT resulted in reduced pain caused by dressing, a faster reepithelization rate, and lower dressing cost than that of conventional moist dressing.

Although a bipedicled deep inferior epigastric artery perforator (DIEP) flap is widely accepted for slim patients with large breasts, we suggest DIEP flap‐based breast reconstruction in which the superficial inferior epigastric artery (SIEA) is supercharged to the branch of thoracodorsal vessel as an alternative, which has not previously been well described. We report the case of a 48‐year‐old breast cancer patient who had a normal body mass index of 23.01 and relatively thin abdominal tissue, with large and ptotic (grade II ptosis) breasts. The mastectomy specimen weighed ~890 g, and the harvested abdominal tissue weighed ~700 g with a size of 32 × 12 cm2. The elliptical‐shaped flap was inset with a 90° counterclockwise rotation, and the lower one‐third of the flap was folded to create a projection. Perfusion of flap was augmented by microvascular anastomosis between the contralateral SIEA and the serratus branch of a thoracodorsal vessel. With a supercharged DIEP flap, nearly the whole lower abdominal tissue (696 g, 99.4% of the elevated flap) could be transferred to obtain a symmetric contour, and there were no complications such as vascular obstruction, flap necrosis, and delayed wound healing during the postoperative course. Using the SIEA pedicle for contralateral abdominal perfusion with elongated branch of the thoracodorsal vessel, aesthetic inset and contouring of the reconstructed breast could be technically enhanced. The DIEP flap with the contralateral SIEA supercharged to the serratus branch of thoracodorsal vessel may be a feasible option for large ptotic breast reconstruction in thin patients.

Background Subbrow blepharoplasty (SBB) has advantages over traditional blepharoplasty in that it results in more natural-looking creases and contours and is more effective for lateral periorbital rejuvenation. However, in older patients with sunken upper eyelid, this procedure might make the superior eyelid sulcus appear worse because the thicker upper eyelid tissue in the subbrow area is replaced by thinner tissue. To overcome this limitation, we developed a de-epithelialized musculocutaneous flap for SBB. Methods From August 2016 to January 2018, 13 patients with sunken upper eyelid deformity underwent SBB. For each of these patients, a typical SBB incision was made, but the tissue usually removed in SBB was dissected as a flap based on the branch of the ophthalmic vessel. After elevation, the flap was transposed or folded to correct the sunken deformity. The results were assessed by the patients themselves and by three plastic surgeons at 6 months postoperatively. Results The mean age of the patients was 63 years (range, 47–81 years). There were no postoperative complications related to wound dehiscence, hypertrophic scarring, or sensory changes. All patients and plastic surgeons provided scores indicating good to excellent results and were satisfied with the cosmetic outcomes. All patients reported improved functional visual acuity after surgery. Conclusions Our technique is simple and effectively addresses both sunken upper eyelid deformity and dermatochalasis. Unlike fat or dermofat grafting, our new technique does not require an additional donor site, and it is more reliable in terms of vascularity.

With the steady rise of health and environmental awareness, the number of bicyclists is increasing. However, there are few epidemiologic studies on bicycling under the influence (BUI). The aim of this study was to determine the prevalence of BUI and the associated risk factors in a representative Korean population. The data of 4,833 adult bicyclists who participated in the Korean National Health and Nutrition Examination Survey (2010-2012) were analyzed. Among the 4,833 participants investigated in this study, 586 (12.1%) had experienced BUI. As participants' age increased, so did the prevalence of BUI (P < 0.001), with the participants who were aged 60-69 showing the highest prevalence of BUI (19.6%). With regard to BUI and drinking habits, the likelihood of being a heavy or highrisk drinker increased with the frequency of BUI (P < 0.001). In addition, there was a positive relationship between the frequency of BUI and alcohol use disorder identification score level. Finally, those who had previous experiences of BUI were significantly more likely to drive and ride motorcycles under the influence (P < 0.001). In conclusion, the prevalence of BUI was 12.1% and several associated risk factors for BUI were elucidated in this study. The development of specific preventive strategies and educational programs aimed at deterring individuals at a high risk of engaging in BUI is expected to reduce the number of alcohol-related bicycle injuries.