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Aim: Fournier's gangrene, traumatic lesions and excision of scrotal skin lesions can all lead to significant scrotal defects. The perineum's diverse bacterial flora, difficulties in providing immobilization, and achieving a natural surface of the testes make testicular cover challenging. Several methods have been described to reconstruct the penoscrotal area. This report aims to present the medial circumflex femoral artery perforator (MCFAP) flap technique in this difficult area. Method: From January 2019 to September 2022, 12 male patients underwent scrotal reconstruction in our clinic using the MCFAP flap due to Fournier's gangrene. These patients were retrospectively evaluated according to age, gender, comorbidities, defect size, donor area, perforators, length of hospital stay, follow-ups and complications. Results / Discussion: In all cases complete scrotal coverage was accomplished with the MCFAP flap. The resulting scrotal shape was satisfactory (Fig. 1). Contamination was controlled by colostomy. In two patients venous insufficiency, and in three patients wound dehiscence was seen. Venous insufficiency improved with leech therapy. Detachments were healed by secondary suturing. Conclusion: For perineoscrotal defects, the MCFAP flap offers a minimal donor site deformity, a one-stage procedure, and an acceptable scrotum-like shape. Additionally, it can be used as a chimeric flap, that includes the gracilis muscle. According to our findings, MCFAP is a superior local flap amongst the limited reconstructive options in this challenging area. Because this flap protects the testicle without raising its temperature, it also gives the testes a pliable local flap without being bulky. Figure 2. The MCFAP flap can reach an axial rotation of 180°. [ABSTRACT FROM AUTHOR]

Aim: Debridement is crucial for facilitating healing in a problematic wound. There are various debridement methods available. The most common way is surgical debridement; however, it cannot be applied to patients with comorbidities or poor general condition. Maggot therapy (MT) is one of the non-surgical treatments that have been applied to a variety of wounds. This study aims to assess the efficacy of maggot therapy. Method: Ten chronic wound patients who applied to our outpatient clinic between 2019 and 2022 received MT. These patients were retrospectively evaluated according to wound type, age, gender, comorbidities, second procedures, recovery, pain level and complications. Results / Discussion: There were three female and seven male cases. The average age was 61. Six patients were diagnosed with diabetic foot and four with sacral decubitus. Seven patients were found to be at risk for an operation due to additional comorbidities. MT provided appropriate area debridement and infection control in this high-risk group. Clean wound tissues were left for secondary healing. In the remaining three cases, MT was used to prepare for an operation. A clean wound bed and optimal granulation tissue were observed (Fig. 1. B,D). Patients with osteomyelitis did not have any negative effects. In 60% of cases, complaints such as disgust and irritation called 'Yuk' factor from the applied larvae were observed. Conclusion: MT decreases time to healing as well as in surgical contraindications. Moreover, this therapy may decrease the risk of major amputations and reduces the need for systemic antibiotics. In spite of lacking clinical evidence, it may be a valuable alternative to surgical debridement according to our clinical experiences. [ABSTRACT FROM AUTHOR]

Aim: There are several methods for covering post-traumatic soft tissue defects, such as skin grafts or flaps. However, these options have some limitations, including a paucity of suitable adjacent tissue, and exposure of neurovascular, bony, or cartilage structures. Therefore, alternative dermal substitutes have been developed for soft-tissue defects. Matriderm® (Dr. Suwelack Skin and Health Care AG, Billerbeck, Germany), a single-layer dermal matrix, has been used often in burn treatment. This study aims to present the use of a dermal matrix in reconstructive surgery. Method: A 39-year-old male presented to the emergency department with a complaint of total amputation of the right ear due to a dog bite. Surgical debridement and proper antibiotic therapy were administered. A two-stage ear reconstruction was then planned using a costal cartilage graft. After the first stage of ear reconstruction surgery, it was noticed that the skin flap on the cartilage prefabrication was thinner, there were detachments in the infected suture lines (Fig. 1). The infected wound was debrided. Afterwards, the exposed cartilage prefabrication, which excludes the perichondrium, was covered with a one-mm Matriderm® and a split-thickness skin graft in a single-step procedure. In addition, a vacuum device was applied. Results / Discussion: The presented case had cartilage exposition, in which Matriderm® allowed the host cell to produce a fuller subdermal bed, over which the skin can epithelize. Complete healing of the skin graft was confirmed through outpatient follow-up at 4 weeks postoperatively. Conclusion: The use of Matriderm® in combination with a skin graft in exposed structures is a simple, feasible method. Therefore, Matriderm® can be indicated in reconstructive surgery, where flap options are limited. [ABSTRACT FROM AUTHOR]