The Experts below are selected from a list of 528 Experts worldwide ranked by ideXlab platform
Goohyun Mun - One of the best experts on this subject based on the ideXlab platform.
-
reconstructing facial contour deformities using stereoscopic Thoracodorsal Artery perforator adipofascial flaps
Microsurgery, 2017Co-Authors: Eun Ji Kim, Soyoung Lim, Saik Bang, Kyeongtae Lee, Jaikyung Pyon, Goohyun MunAbstract:Purpose Correcting facial contour deformities is a challenge, as it demands thoughtful planning on design, composition of flap, and secondary procedures. The Thoracodorsal Artery perforator (TDAP) flap has become a workhorse flap for various reconstructions. In this report, we present our experience of reconstructing facial contour deformities using the free TDAP adipofascial flap, focusing on its customized design. Patients and Method Sixteen patients underwent correction of a facial contour deformity with free TDAP adipofascial flaps from 2002 to 2012. The causes of defects were Romberg disease (n = 7), oncological defects (n = 5), craniofacial microsomia (n = 3), and trauma (n = 1). The flaps were three-dimensionally designed in a contour map fashion to have different thickness according to the defects by adjusting the height of adipose tissue and varying tissue composition. Customized dimension of flaps having reliable perfusion were harvested with minimized sacrifice of overlying skin. Results Flap size ranged from 6 × 3 cm to 25 × 25 cm. Six flaps were based on two perforators and the other 10 on one. Five flaps were harvested in a chimeric fashion. All flaps survived completely. No donor morbidity developed in any case. Seven patients underwent secondary corrections including fat injection or liposuction. Improved contour and symmetry were achieved in all patients and was confirmed by a photographic evaluation. Mean follow-up period was 37.8months. Conclusions Our results suggest that the stereoscopic TDAP adipofascial flaps with diligent secondary approaches may be a reliable alternative for aesthetic reconstruction of facial contour deformities. © 2015 Wiley Periodicals, Inc. Microsurgery, 2015.
-
comprehensive analysis of donor site morbidity following free Thoracodorsal Artery perforator flap harvest
Plastic and Reconstructive Surgery, 2016Co-Authors: Kyeongtae Lee, Ara Kim, Goohyun MunAbstract:Background: The authors evaluated donor-site morbidity following free Thoracodorsal Artery perforator flap harvest comprehensively and investigated patient-and operation-related factors that might contribute to adverse outcomes. Methods: A retrospective analysis was conducted for all cases of free Thoracodorsal Artery perforator flap reconstruction performed between January of 2002 and December of 2014. Donor-site morbidity was evaluated in three aspects: postoperative complications, scar-related problems, and functional impairment. The Quick-Disabilities of the Arm, Shoulder and Hand questionnaire was administered postoperatively to assess donor-site function. Results: A total of 293 patients were analyzed. The median follow-up period was 19.0 months. Donor-site complications developed in 33 patients (11.3 percent). Wound dehiscence (7.4 percent) and seroma (3.0 percent) were the most common complications. Harvesting Thoracodorsal Artery perforator flaps on multiple perforators or segmental latissimus dorsi muscle-chimeric flaps increased the rate of seroma formation but did not affect other donor-site morbidities significantly. Patient American Society of Anesthesiologists classification was a significant predictor of wound dehiscence and overall donor-site complications. Thirty-one patients (10.6 percent) had scar-related problems, including 18 hypertrophic and 13 widened scars. A transverse skin paddle design had a significant protective effect on developing scar-related problems, compared with the nontransverse design. The mean Quick-Disabilities of the Arm, Shoulder and Hand questionnaire score was 2.68 (range, 0 to 18.2), and 90 percent of patients scored less than 10. Flap dimensions were positively correlated with the questionnaire score. Conclusions: The present study suggests that the free Thoracodorsal Artery perforator flap is associated with low donor-site morbidity and minimal dysfunction. Careful consideration of patient condition and thoughtful planning could further minimize donor-site morbidity. CLINICAL QUESTION/LEVEVL OF EVIDENCE: Therapeutic, IV.
-
microsurgical pedicle lengthening for pedicled Thoracodorsal Artery perforator flap transfer
Annals of Plastic Surgery, 2014Co-Authors: Bo Young Park, Sung Wook Seo, Goohyun MunAbstract:The pedicled Thoracodorsal Artery perforator flap has been shown to be an effective option for reconstruction of various regions, including the breast, axilla, upper arm, lateral chest, and shoulder area. However, the original length of the pedicle limits the flap's reach to remote locations. We devised a technique that involves microsurgical lengthening of the pedicle to extend the arc of rotation of the pedicled perforator flap. After exposure of the subscapular vascular tree, we divided the Thoracodorsal vessel at the point of bifurcation to the serratus branch and then the pedicle was reconnected to the distal end of the serratus branch. Here, we present 2 cases in which this technique was effectively applied to reconstruct a defect of the elbow using a Thoracodorsal Artery perforator flap with a pedicle lengthening procedure.
-
plantar reconstruction with free Thoracodorsal Artery perforator flaps
Journal of Plastic Reconstructive and Aesthetic Surgery, 2013Co-Authors: Byungjoon Jeon, Soyoung Lim, Jaikyong Pyon, Saik Bang, Kyeongtae Lee, Goohyun MunAbstract:Summary Purpose The plantar region presents unique challenges for reconstructive surgeons. Reconstruction using a Thoracodorsal Artery perforator (TDAP) flap yields favourable results in various fields of microsurgical reconstruction, but reports on the reconstruction of plantar defects are sparse. Here, the authors present their experience in the reconstruction of various defects in the plantar region using free TDAP flaps. Methods From January 2005 to July 2011, 40 free TDAP flaps were transferred for reconstructive purposes to restore skin and soft-tissue defects in the plantar region. Hospital and outpatient records were reviewed independently for all patients. A patient questionnaire including five questions was administered to subjectively evaluate reconstructive results. Results A total of 24 male and 16 female patients were enrolled in this study. The mean age was 47.8 years and ranged from 7 to 77 years. The most common cause of defect was oncology related ( n = 21), followed by trauma-related ( n = 11), diabetes-related ( n = 6) and other causes. The average flap size was 63.7 cm 2 and ranged from 25 to 212 cm. 2 All flaps survived except for one, resulting in a below-knee amputation. The mean follow-up period was 20.4 months. Four patients underwent secondary revisional procedures, including simple defatting in two patients and excision of redundant skin due to flap instability in two patients. The satisfaction surveys were completed by 34 (85%) patients. Patients reported high levels of satisfaction in terms of pain, limitation of daily activities, donor site satisfaction and overall satisfaction. Most patients were satisfied and reported that they would recommend the procedure to others. Conclusion An appropriately thinned free TDAP flap with thick skin provided favourable outcomes with high patient satisfaction and is a valuable option for the restoration of skin and soft-tissue defects in the plantar region.
-
reliable harvesting of a large Thoracodorsal Artery perforator flap with emphasis on perforator number and spacing
Plastic and Reconstructive Surgery, 2011Co-Authors: Jin Hee Hwang, Soyoung Lim, Jaikyong Pyon, Saik Bang, Goohyun MunAbstract:Background: Thoracodorsal Artery perforator flaps are useful for covering extensive defects because of their generous donor-site dimensions. However, large flaps increase the risk of partial flap necrosis, and a reliable means of sizing Thoracodorsal Artery perforator flaps has not been devised. The authors reviewed a series of large Thoracodorsal Artery perforator flap transfers performed under various reconstructive conditions to evaluate surgical outcomes and placed emphasis on flap design and harvesting technique. Methods: A consecutive series of large Thoracodorsal Artery perforator flaps (>20 cm long) performed between November of 2005 and March of 2010 were included in this study. Patient charts, operative records, and photographs were reviewed. Results: A total of 20 flaps with an average size of 25 × 11 cm in 20 patients were identified; the largest flap measured 32 × 13 cm. The average number of perforators included was 2.6 per flap (range, one to four). Four different harvesting techniques were used, depending on perforator numbers and locations. All large flaps survived without sizable partial flap necrosis. Complications included wound dehiscence in one donor and two recipient sites; all healed after wound repair. Tip necrosis of a small area developed but healed with conservative wound care. Conclusions: This study reports the clinical safety of large Thoracodorsal Artery perforator flaps with customized thickness control, which can be reliably harvested beyond 20 cm in length by carefully considering perforator numbers and locations. To optimize tissue perfusion in these large flaps, effort is required to capture multiple perforators from various sources and to obtain an ideal arrangement. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
Douglas B. Chepeha - One of the best experts on this subject based on the ideXlab platform.
-
restoration of the orbital aesthetic subunit with the Thoracodorsal Artery system of flaps in patients undergoing radiation therapy
Skull Base Surgery, 2013Co-Authors: Eric J. P. Chanowski, Keith A Casper, Avraham Eisbruch, Jason Heth, Lawrence J Marentette, Mark E Prince, Jeffrey S Moyer, Douglas B. ChepehaAbstract:Objectives To demonstrate the advantages of the Thoracodorsal Artery scapular tip autogenous transplant (Tdast) for patients requiring restoration of the orbital aesthetic subunit. Design Prospective case series. Setting Tertiary center. Participants Ten patients (M:F,6:4) with a mean age of 56 years (range, 21 to 78 years) underwent restoration of the orbital aesthetic subunit and radiation therapy between 2001 and 2008. Main Outcome Measures The two reconstructive advantages of the Thoracodorsal Artery system of flaps for orbital reconstruction are a long pedicle and the suitability of the scapula tip to meet the three-dimensional requirements of the orbit. Patients were assessed 1 year or more after treatment for cosmetic outcome, work status, and socialization. Results Eight of 10 patients benefited from the three-dimensional nature of the scapula tip bone and 7 of 10 avoided vein grafting. Four of five evaluable patients reported “frequently” socializing outside their home. Four of five evaluable patients working before undergoing their treatment were able to return to work posttreatment. Seven of nine patients with postoperative photographs had minimal or no facial contour deformity. Conclusions The Tdast can restore orbital contour without osteotomy, and the Thoracodorsal Artery system of flaps has a long vascular pedicle that reduces vein grafting. Patients have an acceptable cosmetic result and return to preoperative work status and socialization.
-
Microvascular cricoid cartilage reconstruction with the Thoracodorsal Artery scapular tip autogenous transplant.
The Laryngoscope, 2011Co-Authors: Eric J. P. Chanowski, Marc J. Haxer, Douglas B. ChepehaAbstract:Conservation laryngeal surgery has been limited by difficulties with partial resection of the cricoid. Numerous options have been suggested that include temporoparietal flaps, free cartilage grafts, radial forearm free tissue transfers, and tracheal autotransplantation with vascular carriers. The authors present a one-stage procedure for the reconstruction of the cricoid cartilage based on the Thoracodorsal Artery scapular tip (Tdast) autogenous transplant that uses the curved tip of the scapula and does not create a secondary tracheal defect. Because the Tdast is a vascularized graft it may withstand radiation treatment.
-
Thoracodorsal Artery scapular tip autogenous transplant vascularized bone with a long pedicle and flexible soft tissue
Archives of Otolaryngology-head & Neck Surgery, 2010Co-Authors: Douglas B. Chepeha, Eric J. P. Chanowski, Mark E Prince, Jeffrey S Moyer, Samir S Khariwala, Justin W Zumsteg, Kelly M Malloy, Assuntina G SaccoAbstract:Objective To demonstrate that the 3 reconstructive advantages of the Thoracodorsal Artery scapular tip transplant (Tdast), a long pedicle, independently mobile tissue components, and the 3-dimensional nature of the scapular tip, will improve the quality and success of complex reconstructions by avoiding vein grafting, preventing the need for 2 separate transplants, and facilitating bony inset. Design Prospective case series. Setting Tertiary care academic medical center. Patients Twenty-one patients (male to female ratio, 16:5; mean age, 52 years) underwent reconstruction of the upper, middle, and lower face from 2001 through 2006. Indications for reconstruction were tumor ablation in 11 patients, secondary reconstruction in 4 patients, osteoradionecrosis in 4, and posttraumatic reconstruction in 2. Seventeen patients underwent radiation. Interventions All patients underwent harvest of an autogenous transplant of scapular tip bone and latissimus dorsi soft tissue based on the Thoracodorsal Artery. The mean bone length was 5.2 cm (range, 2.5-9.0 cm), and the mean cutaneous surface area was 68 cm2(range, 20-250 cm2). Main Outcome Measures Reduction of vein grafting, avoidance of 2 transplants, use of the triangular shape of the scapular tip in reconstruction, complications, and shoulder function. Results The success rate of transplantation was 100%. The use of this transplant avoided vein grafting in 16 patients and the need for 2 separate transplants in 11 patients, and the 3-dimensional nature of the scapular tip facilitated inset in 13 patients. In 14 patients, more than 1 of these reconstructive advantages was achieved. In 6 patients, all 3 were accomplished. Eleven patients experienced a complication. The major complication rate was 33%, and the minor complication rate was 33%. The mean Constant-Murley test of shoulder function score was 87 of 100 (range, 74-100). Conclusions The Tdast is an excellent choice for reconstruction in the head and neck as an alternative to procedures requiring vein grafting and multiple free tissue transplants, or in which the 3-dimensional contour of the scapular tip aids in reconstruction. The complication rate should be assessed in the context of the risk factors of the patient population and the outcome with respect to stable employment, increasing body mass index, and maintenance of shoulder function.
Youn Hwan Kim - One of the best experts on this subject based on the ideXlab platform.
-
resurfacing the donor sites of reverse sural Artery flaps using Thoracodorsal Artery perforator flaps
Archives of Plastic Surgery, 2021Co-Authors: Seong Oh Park, Youn Hwan KimAbstract:Background The reverse sural Artery (RSA) flap is widely used for lower extremity reconstruction. However, patients sometimes suffer from donor site complications such as scar contracture and paresthesia, resulting in dissatisfaction with the aesthetic outcomes. This study investigated the characteristics of donor site morbidity associated with RSA flaps and described our experiences of dealing with complications by performing resurfacing surgery using Thoracodorsal Artery perforator (TDAP) flaps. Methods From April 2008 to August 2018, a total of 11 patients underwent contracture release and resurfacing surgery using TDAP flaps due to donor morbidity associated with RSA flaps. All affected donor sites were covered with a skin graft, the most common of which was a meshed split-thickness skin graft (six cases). Results Eight of the 11 patients (72.7%) suffered from pain and discomfort due to scar contracture, and seven (63.6%) complained of a depression scar. The donor sites were located 6.3±4.1 cm below the knee joint, and their average size was 140.1 cm². After resurfacing using TDAP flaps, significant improvements were found in the Lower Extremity Functional Scale (LEFS) scores and the active and passive ranges of motion (AROM and PROM) of the knee joint. The LEFS scores increased from 45.1 to 56.7 postoperatively (P=0.003), AROM increased from 108.2° to 118.6° (P=0.003), and PROM from 121.4° to 126.4° (P=0.021). Conclusions Planning of RSA flaps should take into account donor site morbidity. If complications occur at the donor site, resurfacing surgery using TDAP flaps achieves aesthetic and functional improvements.
-
Lower Extremity Salvage with Thoracodorsal Artery Perforator Free Flap in Condition of Symmetrical Peripheral Gangrene
Hindawi Limited, 2018Co-Authors: Soo Yeon Lim, Il Hoon Sung, Youn Hwan Kim, Gyeong Hoe Kim, Dong Woo Jang, Jung Soo Yoon, Sang Wha KimAbstract:Symmetrical peripheral gangrene (SPG) is rare but devastating complication which is characterized by symmetrical ischemic change of the distal extremities. In this report, we describe our management protocol for SPG, focusing on surgical approaches. Between January 2007 and February 2016, 10 Thoracodorsal Artery perforator (TDAP) free flaps were performed in 6 patients with SPG. Three patients were male and mean age was 56 (range, 44–69) years. All the patients were in shock. The causes of shock were sepsis in 4 cases, respiratory arrest in 1 case, and hypovolemia in 1 case. Eight transmetatarsal amputations and 2 Lisfranc amputations were performed. Flap sizes ranged from 7 × 11 cm to 25 × 15 cm. There were 3 cases of partial necrosis of the flap: two healed conservatively with dressings and one required skin graft. Three of the patients were later able to walk independently at Functional Ambulation Classification (FAC) level 6, one patient could walk independently on level surfaces at FAC level 5, and 2 could walk independently using walking aids, classified at FAC level 4. The average follow-up period was 18 (range, 6–54) months. In patients with SPG, minimal bone amputation and foot salvage with TDAP flaps were successful. Separate reconstruction of bone and soft tissue had good outcomes
-
toe resurfacing with a thin Thoracodorsal Artery perforator flap
Microsurgery, 2017Co-Authors: Youn Hwan Kim, Jeong Tae Kim, M Ki Ho D Kim, Kunyong Sung, Sang Wha KimAbstract:Background In toe reconstruction, amputation procedures are much more common than salvage procedures. However, toe resurfacing, rather than amputation, provides superior functional and aesthetic results. In this study, we report the clinical outcomes of toe resurfacing using a thin Thoracodorsal Artery perforator flap. Patients and methods Between January 2004 and June 2013, a total of 15 patients underwent toe resurfacing using Thoracodorsal Artery perforator flaps. Thin flaps were harvested by discarding the deep adipose layer. Twelve cases involved a great toe defect, three, a second toe defect, three, a third toe defect, and one, a fourth toe defect. Patient ages ranged from 19 to 82 years (mean, 42.9 years). The mechanism of injury varied, including crushing injury, degloving injury, and diabetic foot infection. Results The size of Thoracodorsal Artery perforator flap ranged from 4 × 3 to 20 × 8 cm2 and the thickness of the flap ranged from 4 to 9 mm (mean, 6.5 mm). All flap survived completely without complications. The mean follow-up period was 18.8 months (range, 12–60 months). Only one patient with rheumatoid arthritis had mild gait disturbance. All patients were satisfied with the aesthetic and functional results. Conclusion Toe resurfacing with thin Thoracodorsal Artery perforator flaps appears to be a safer and more reliable option than amputation for preserving their function. © 2015 Wiley Periodicals, Inc. Microsurgery, 2015.
-
Reconstruction of the lateral malleolus and calcaneus region using free Thoracodorsal Artery perforator flaps.
Microsurgery, 2015Co-Authors: Sang Wha Kim, Dong Hyun Youn, Kyu Tae Hwang, Il Hoon Sung, Jeong Tae Kim, Youn Hwan KimAbstract:Reconstruction of the lateral malleolus or calcaneus region is challenging because of poor vascularity, minimal presence of soft tissue, and difficulties with flap positioning during and after the operation. In many cases, local flaps are limited in terms of size, durability, and vascularity. Free tissue transfer can be useful for complicated wounds. We report here on the results of the reconstruction in this region using free Thoracodorsal Artery perforator flaps. Between October 2010 and October 2013, 16 cases of lateral malleolus or calcaneus defects were reconstructed using free Thoracodorsal Artery perforator flaps. The defects varied from 2 × 5 cm(2) to 12 × 16 cm(2), and the flaps from 3 × 5 cm(2) to 10 × 15 cm(2). Two cases were reconstructed using chimeric-pattern flaps. Only the superficial adipose layers were harvested for all the flaps, without further thinning or debulking process. Five cases with complications occurred, including three cases of partial necrosis of the flap and two cases of venous congestion caused by thrombosis and compression of the venous pedicle, and one flap was totally lost. The mean follow-up duration was 11.8 months. All the patients were able to wear shoes. All but one were able to walk. The Thoracodorsal Artery perforator flap can be made super-thin, allowing patients to wear shoes, and it can be harvested in a chimeric-pattern for complex defects. Therefore, it may represent a viable alternative choice for the reconstruction of the lateral malleolus and calcaneus region.
-
foot reconstruction using a serratus anterior muscle flap from the same donor site after failure of a Thoracodorsal Artery perforator flap
Microsurgery, 2014Co-Authors: M Sang Wha D Kim, Jeong Tae Kim, M Young Hun D Kwon, Youn Hwan KimAbstract:The free flap failure rate for the lower extremities is high, which adversely affects limb salvage efforts. In this article, we report a case of failure of a Thoracodorsal Artery perforator flap, which was simultaneously reconstructed with a serratus anterior muscle flap from the same donor site. A 56-year-old male patient had infected wound for 3 months due to Achilles tendon rupture. We reconstructed the defect using a Thoracodorsal Artery perforator flap. However, 2 days after the operation, we found the congested flap. We were obliged to discard the whole flap and harvested a serratus anterior muscle flap from the same donor site. The patient's foot healed uneventfully. After flap failure, the use of a second free flap from the same donor site may be an effective and safe procedure in specific cases. © 2013 Wiley Periodicals, Inc. Microsurgery 34:153–156, 2014.
Wanyuk Kim - One of the best experts on this subject based on the ideXlab platform.
-
impact of perforator mapping using multidetector row computed tomographic angiography on free Thoracodorsal Artery perforator flap transfer
Plastic and Reconstructive Surgery, 2008Co-Authors: Goohyun Mun, Hyung Joon Kim, Myungkyu Cha, Wanyuk KimAbstract:Background: The preoperative localization of Thoracodorsal Artery perforators has been a challenge because of their topographic variation. Methods: From November of 2005 to January of 2007, 25 patients underwent free Thoracodorsal Artery perforator flap transfer for reconstruction of the lower extremities (22 flaps) and the head and neck (three flaps). All of the patients underwent multidetector-row computed tomographic angiography for preoperative perforator mapping. The computed tomographic findings were compared with the acoustic Doppler flowmetric and intraoperative findings. Surgical outcomes were compared with those of a historical group of patients treated before the adoption of computed tomography-based perforator mapping. Results: The flap sizes ranged from 3 X 5 cm to 27 X 13 cm. One to four perforators (mean, 2.2) were marked on the three-dimensional computed tomographic image for each patient and the locations correlated with the handheld Doppler examination. Intraoperatively, all perforators marked were confirmed, and three additional perforators that had not been identified on the computed tomographic images were observed. All of the flaps survived, with the exception of two cases with marginal necrosis. Concrete planning based on knowledge of the precise location of the perforators allowed a shorter harvest time, minimized the incision for flap harvest, particularly with small flaps, and enabled the planned use of multiple perforators for better perfusion or complex designs. Conclusions: Perforator mapping with preoperative multidetector-row computed tomographic angiography is valuable for both planning and executing Thoracodorsal Artery perforator flap transfer. The targeted perforator flap harvesting allows a safe and straightforward harvest and an elegant reconstruction, with less donor-site morbidity.
Assuntina G Sacco - One of the best experts on this subject based on the ideXlab platform.
-
Thoracodorsal Artery scapular tip autogenous transplant vascularized bone with a long pedicle and flexible soft tissue
Archives of Otolaryngology-head & Neck Surgery, 2010Co-Authors: Douglas B. Chepeha, Eric J. P. Chanowski, Mark E Prince, Jeffrey S Moyer, Samir S Khariwala, Justin W Zumsteg, Kelly M Malloy, Assuntina G SaccoAbstract:Objective To demonstrate that the 3 reconstructive advantages of the Thoracodorsal Artery scapular tip transplant (Tdast), a long pedicle, independently mobile tissue components, and the 3-dimensional nature of the scapular tip, will improve the quality and success of complex reconstructions by avoiding vein grafting, preventing the need for 2 separate transplants, and facilitating bony inset. Design Prospective case series. Setting Tertiary care academic medical center. Patients Twenty-one patients (male to female ratio, 16:5; mean age, 52 years) underwent reconstruction of the upper, middle, and lower face from 2001 through 2006. Indications for reconstruction were tumor ablation in 11 patients, secondary reconstruction in 4 patients, osteoradionecrosis in 4, and posttraumatic reconstruction in 2. Seventeen patients underwent radiation. Interventions All patients underwent harvest of an autogenous transplant of scapular tip bone and latissimus dorsi soft tissue based on the Thoracodorsal Artery. The mean bone length was 5.2 cm (range, 2.5-9.0 cm), and the mean cutaneous surface area was 68 cm2(range, 20-250 cm2). Main Outcome Measures Reduction of vein grafting, avoidance of 2 transplants, use of the triangular shape of the scapular tip in reconstruction, complications, and shoulder function. Results The success rate of transplantation was 100%. The use of this transplant avoided vein grafting in 16 patients and the need for 2 separate transplants in 11 patients, and the 3-dimensional nature of the scapular tip facilitated inset in 13 patients. In 14 patients, more than 1 of these reconstructive advantages was achieved. In 6 patients, all 3 were accomplished. Eleven patients experienced a complication. The major complication rate was 33%, and the minor complication rate was 33%. The mean Constant-Murley test of shoulder function score was 87 of 100 (range, 74-100). Conclusions The Tdast is an excellent choice for reconstruction in the head and neck as an alternative to procedures requiring vein grafting and multiple free tissue transplants, or in which the 3-dimensional contour of the scapular tip aids in reconstruction. The complication rate should be assessed in the context of the risk factors of the patient population and the outcome with respect to stable employment, increasing body mass index, and maintenance of shoulder function.
