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Scrotal skin loss can occur following trauma, Fournier's gangrene, post tumour excision, burns, etc. There are many techniques described in the literature including residual scrotal skin mobilization, skin grafts, pedicled and free flaps. The management is complex and challenging shown by the multiplicity of flaps and techniques described in the literature. We used a modified pudendal thigh flap to reconstruct scrotal defects in five patients. This study describes the vascularity of the flap, technique of elevation and the inset of the flap. The elevation and particularly the insetting make it different from other flaps raised on this vascular network for scrotal reconstruction. This pedicled flap is robust, reliable, resilient and produces a neo-scrotum that looks natural in appearance, offers good-quality skin cover and cushion to the testes as well as protective sensation.

Summary Notching, or ‘whistle deformity', is a common vermilion deformity among patients with cleft lips. Vermilion volume deficiency may also be present secondary to trauma or tumour excision. Herein, we present a new flap model to repair such vermilion deformities. Six patients were included in the study. Running V-flaps prepared from the oral mucosa were used. While the underlying cause of vermilion deficiency was cleft-lip surgery in four of the patients, the indication for surgery was trauma related in two patients. In all patients, the volume deficiency was corrected. No patient exhibited scarring, colour mismatch or asymmetry. We believe that our new flap model can be a reliable alternative in secondary vermilion deficiencies.

The Abbe flap procedure has typically been indicated in cases of tissue defects of the upper lip after injury or tumour excision. However, this method requires two-stage reconstruction. In this report, we describe for the first time a novel one-stage reconstruction method using the inferior labial artery island flap. A 54-year-old man presented with a left upper lip defect and a scar contracture between the upper lip and the left cheek. We planned to reconstruct the lip defect using the inferior labial artery island flap. The inferior labial artery island flap was harvested with a vascular pedicle, and the vascular pedicle was returned through the inside of the flap. The flap survived completely, and liquid leakage from the lip and the appearance of the injured area were clearly improved. For this new technique, we converted the inferior labial flap to a vascular pedicled island flap, which increased its flexibility. This long vascular pedicle could be returned through the inside of the flap. Thus, this flap appears to be ideal for one-stage reconstructions of full-thickness upper lip defects.

Summary This case report demonstrates a modification of the so-called ‘Extended V-Y Flap' used to simultaneously reconstruct a defect involving the upper lip, floor of nose and alar rim following tumour excision. We hope that this case serves as a reminder of the versatility of the V-Y flap in the nasolabial region, and its considerable capacity for augmentation.