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Objective: This article aimed to present how to determine breast volume in D.I.E.P flap breast reconstruction using water displacement immediately after mastectomy for cancer treatment. Materials and Methods: Twenty-nine patients underwent immediate breast reconstruction with D.I.E.P flap post total mastectomy. For all patients, measurements included removal of breast volume, flap dissection volume, and removed flap volume to calculate the volume of flap used for breast reconstruction. Patient satisfaction with breast volume were assessed using survey at 6-month follow-up. Results: The mean breast removal volume was 378.79±113.84 cc. Average D.I.E.P flap volume was 573.62 ± 130.34 cc (340 - 900 cc). The reconstructed breast volume was 408.97 ± 111.27 cc. The reconstructed breast volume is 10.02 ± 7.4% larger than the removed breast. After 6 months of surgery, the BREAST-Q quantitative score of satisfaction accounted for 85.19% to 96.3%. Conclusion: In determining the breast volume in immediate breast reconstruction using D.I.E.P flap, the method of water displacement in the beaker is an effective, easy to implement, and satisfactory method. Keywords: Immediate breast reconstruciton, Volume change, Volumetric, Water displacement; D.I.E.P flap

Aims: To evaluate the results of covering limb soft tissue defects with medial sural artery perforator free flap. Materials and Method: Non-randomised interventional study was performed on 10 cases of limb soft tissue defects exposing tendons, bones, blood vessels or nerves covered by medial sural artery perforator free flap. The lesion characteristics and flap features have been described. The effectiveness of defect coverage and the impact of the donor site were evaluated at the time of hospital discharge and 3 months after surgery. Results: 7 soft tissue defects of the lower limbs and 3 defects of the fingers, exposing tendons and bones were included in research. The average size of flaps was 5.9x11.2 cm2, the average thickness of flaps was 10.2±2.1mm, the average length of vessel pedicles was 10.3±2.6 cm and there were average of 1.9 perforators per flap. No postoperative complications were recorded. 100% of the flaps survived and covered the defects complettly. 100% of the donor sites were closed directly. After 3 months, 8/10 patients showed good limb function, 2/10 patients suffered from limited function at recontructed limb due to severe primary injury despite of good results in covering and healing. 7/10 flaps were flat, 3/10 flaps were thicker than expectation. 100% of the donor sites showed normal function. Although 6/10 cas appeared hypertrophic scars and 7/10 cas showed hyperpigmentation but all of the patients were sactisfied. Conclusions: The medial sural artery perforator flap has the advantages of being thin, less morbidity at the donor site and being suitable for medium soft tissue limb defects. Key words: Soft tissue limb defects, medial sural artery perforator flap, free flap.

Conjoined twins are rare, and each set of conjoined twins has a unique conjoined anatomy. It is necessary to perform separation to increase the chance of patient survival. Tissue expansion is an advanced technique for providing sufficient soft tissue and skin for wound closure. We report the successful application of rapid tissue expansion in 10-month-old xipho-omphalopagus conjoined twins in Vietnam. A tissue expander was placed on the anterior body between the sternum and umbilicus with a baseline of 70 mL sterile saline (0.9% NaCl). The first injection into the tissue expander began on the 6th day after expander insertion, and injections continued every 2 days with approximately 30–70 mL per injection according to the expansion of the skin. The expander reached 335 mL after six injections and within 10 days. In order to prepare for surgical separation, expansion was completed on the 15th day after insertion. The expanded skin area was estimated to be 180 cm2, which was sufficient to cover both patients’ skin deficiencies. The twins presented for surgical separation 6 days following the completion of tissue expansion. Both babies were discharged in good health 1 month after separation.