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Background: Abdominoperineal resection (APR) is the surgical treatment of low-lying rectal cancers and other pelvic malignancies. Plastic surgery offers a means to close these complicated defects through obliterating dead space, providing tension-free closure, and introducing vascularized tissue into a radiated field. The indications for reconstructive surgery and choice of reconstruction are debatable. This study aims to identify when and which reconstruction is preferred., Methods: A retrospective comparative analysis was performed on all patients undergoing APR at Stanford Hospital between 2007 and 2013. Data points included demographics, disease, operative positioning, and postoperative complications. Univariate analysis and multivariate logistic regression analysis were performed to identify markers of flap reconstruction and complications., Results: A total of 178 APRs were performed, of which 51 underwent flap reconstruction. The odds ratio of all complications between flap and primary closure was not significant at 1.36 (0.69-2.66). Independent predictors for flap reconstruction included prone positioning, anal squamous cell carcinoma (SCC), prior smoking, and neoadjuvant chemoradiation therapy. Univariate predictors of flap reconstruction included female gender and combined vaginectomy. Independent predictors of complications included current and prior smoking. Muscle flap closure had lower recipient site complications than V-to-Y advancement closure (20% vs. 50%, p = 0.039)., Conclusion: Flap reconstruction following APR is associated with prone positioning, neoadjuvant chemoradiation, female gender, prior smoking, and anal SCC resections. Pedicled muscle flaps had a significantly lower rate of recipient site complications than V-to-Y advancement flaps and therefore should be the flap reconstruction of choice. The vertical rectus abdominis myocutaneous flap was superior to the gracilis flap in terms of the overall reduction of complications., (Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: Laterally based nasalis myocutaneous flaps pedicled on the superior nasal superficial musculoaponeurotic system (SMAS), which contains the bilateral dorsal nasal arteries, have not been utilized for the reconstruction of nasal defects., Methods: According to the location and size of the nasal defects, a V-Y advancement nasalis myocutaneous flap was designed along the proximal alar groove and nasolabial fold. The flap was superficially elevated from the perichondrium, and the nasal SMAS above the flap was dissected as the unilateral pedicle. After the flap was rotated and advanced to the defect, the secondary defect was primarily closed., Results: A total of 20 cases of nasal defects, including six cases of nasal dorsum, five cases of nasal tip, four cases of nasal tip-alar junctions and five cases of nasal tip-dorsum junctions, were reconstructed using this method. The defect size ranged from 0.8 × 0.8 cm to 2 × 1.8 cm. All of the flaps survived with satisfactory aesthetics and function. All of the patients were postoperatively followed up for 6-12 months., Conclusion: Application of the V-Y advancement nasalis myocutaneous flaps pedicled on a nasal SMAS is appropriate for the reconstruction of small to medium sized nasal tips and peri-tip defects, and it can achieve satisfactory results due to its simple design, convenient transfer, reliable blood supply and concealed incision., (Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)