title: Improvement of ischemic or congested wound conditions by reconstruction with microsurgical flaps.
abstract: BACKGROUND
  Intractable chronic wounds share the basic problem of the environment being unfavorable for wound healing and prone to infection, inflammation, and recurrences. Microsurgical flap provides a healthy, well-vascularized normal tissue to compromised intractable environment, and promotes wound healing. In this report, we present the results of microsurgical flaps used for the reconstruction of chronic intractable conditions including chronic ulcer with an ischemic environment and pathologic lesions with a congestive environment.
  
  
  METHODS
  From 1997 to 2015, 18 patients received microsurgical flaps for chronic intractable conditions. Among them, three patients had radiation ulcers with an ischemic environment and 15 had pathologic lesions with a congested environment, such as vascular malformations. Nine patients were male, and nine were female. The mean age was 31.9 years. All patients were treated using radical excision and reconstruction with microsurgical tissue transfer.
  
  
  RESULTS
  All flaps survived completely. Among three patients with radiation ulcers, two had minor wound disruptions, which were managed conservatively. No further episodes of infections or breakdowns occurred. Among 15 patients who had pathologic lesions, one suffered facial palsy of the forehead. No complications in terms of infection, or recurrences were noted, and resolution of the residual surrounding lesions was observed on follow-ups. No donor related problems occurred in any patients. The mean follow-up period was 10.7 years.
  
  
  CONCLUSIONS
  In this report, we present the results of reconstruction of chronic intractable conditions using microsurgical flaps. The reconstruction using microsurgical flaps was clinically successful, with long-term improvement of surrounding tissues and no recurrence.
authors.affiliation: Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, Korea.
authors.forename: Jeong Tae
authors.initials: JT
authors.lastname: Kim
authors.affiliation: Department of Plastic and Reconstructive Surgery, College of Medicine, Seoul National University, Seoul National University Hospital, Seoul, Korea.
authors.forename: Sang Wha
authors.initials: SW
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D002675:Child, Preschool; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D016896:Treatment Outcome; D014456:Ulcer / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D055815:Young Adult
keywords: Microsurgical flaps; Radiation ulcer; vascular malformation