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Introduction In Japan, transgender individuals have historically had limited therapeutic options, prompting many to seek gender‐affirming surgeries in private or foreign clinics because of restricted access to public hospitals. This has led to challenges for patients undergoing surgery. Case presentation A transgender man underwent surgery at a private clinic and experienced recurrent complications. Subsequent examination at another clinic and our hospital revealed limited medical records, complicating our understanding of this case. After a detailed investigation, the urethrocutaneous and urethrovaginal fistulas were identified and addressed by joint urologists and plastic surgeons, resulting in no recurrence after 1 year. Conclusion This case underscores the importance of thorough preoperative assessment with a flexible mindset, emphasizing the need to avoid being misled by inadequate records or appearances in complication management of gender‐affirming surgery. Collaborative efforts among healthcare professionals based on comprehensive evaluations lead to safer complication treatments.

Purpose: to develop a method for assessing metabolic changes in pedicle skin flaps using spectrofluorimetry in eyelid neoplasm surgery. Material and methods. 14 patients (mean age 74.50 ± 7.14 years) were operated for eyelid neoplasms with tissue defects replaced by pedicle flaps. The area of eyelid lesion achieved 90 %. In 100 % of cases, a histological examination revealed basal cell carcinoma. Metabolic changes of the skin in the transplanted flap and in the symmetrical area of the fellow eye were assessed using the spectrofluorimetric method 3 days and 3 months after the surgery. A number of successive spectra of fluorimetric parameters were taken from each site, whereupon the mean values of the Metabolic Shift Index were calculated. Results. Differences in the spectrofluorimetric parameters of the metabolic shift between the area with the transplanted flap and the symmetrical area were revealed on the third day after surgery (p = 0.00058) and 3 months after it (p = 0.0317). The obtained results indicate a partial preservation of the hypoxic state of the skin on the third postoperative day and the complete restoration of trophism 3 months after the surgery (p = 0.043), as well as the onset of scarring of the transplanted flap by the latter time point. Conclusion. A technique for assessing metabolic changes in eyelid skin has been developed, which enabled the establishment of normal spectrofluorimetric values in this area and helped reveal the changes in the indices of metabolic shift in the transplanted pedicle flaps in the early postoperative periods and throughout the entire follow-up period. 3 months after the surgical treatment, the indices of metabolic changes in the transplanted pedicle flap come close to normal values.

Background: Reconstruction of the head and neck is dominated by free flaps, and for bone reconstruction by fibula and scapula flaps. However, this choice is sometimes difficult to make in patients who cannot tolerate an extensive and lengthy surgical procedure. In addition, vascular micro-anastomoses are sometimes complicated in patients who have been previously irradiated. Pedicle flaps remain an option and can sometimes be considered as first choice for head and neck reconstruction. Purpose: In this study, we describe the feasibility of a split temporal muscle pedicled flap with coronal harvesting for a reconstruction that can reach the midline. Study design, sample, covariates: Ten fresh-frozen human cadaver heads were dissected, and the length of the split flap was noted, followed by the length of the non-split flap. Results: The mean length was 155.7 mm (± 20.0) for the split flap, from the point of rotation to the tip of the coronoid process. These results coincide with the tragus-midline distance, which makes it possible to consider reconstruction of the midline, especially the maxilla and the mandible, which has not yet been described in the literature. Conclusions and relevance: This technique would then allow a supply of pedicled vascularized bone for loco-regional reconstruction. [ABSTRACT FROM AUTHOR]

Abstract Hypoxia-Inducible Factor-1α (HIF-1α) has presented a new direction for ischemic preconditioning of surgical flaps to promote their survival. In a previous study, we demonstrated the effectiveness of HIF-1a DNA plasmids in this application. In this study, to avoid complications associated with plasmid use, we sought to express HIF-1α through mRNA transfection and determine its biological activity by measuring the upregulation of downstream angiogenic genes. We transfected six different HIF-1a mRNAs–one predominant, three variant, and two novel mutant isoforms–into primary human dermal fibroblasts using Lipofectamine, and assessed mRNA levels using RT-qPCR. At all time points examined after transfection (3, 6, and 10 h), the levels of HIF-1α transcript were significantly higher in all HIF-1α transfected cells relative to the control (all p

The medial arm flap (MAF) has been used as a pedicle flap and free flap to reconstruct various deformities, including those of the head and neck, axilla, elbow, chest, and hand. This study reviews the anatomy of the flap, the technique of flap harvest, its clinical applications, and a systematic review of the current published literature. An online systematic review of MEDLINE, EMBASE, PubMed, and The Cochrane Library from inception to September 30, 2023, was completed. Studies that investigate the anatomy, technique or clinical outcomes of medial arm flaps were included. Clinical data extracted includes patient, defect, flap characteristics, complications, and take-back procedures. Anatomic data extracted includes anatomical variations, and vascular characteristics and patterns. Between 1980 and 2023, 50 papers were published outlining the medial arm flap. Anatomic studies detail the anatomy of 384 medial arms, and outcomes are reported for 283 MAFs (75 free flaps and 208 pedicle flaps). The superior ulnar collateral artery is most commonly cited as the dominant arterial supply to the middle third of the medial arm. The majority of patients required reconstruction post-burn (39.2%), trauma (17.7%), and tumor excision (12.4%). MAFs were mostly used to reconstruct defects of the head and neck (41.7%), the hand and wrist (21.9%), and the elbow (16.3%). Eleven flaps (4.1%) suffered partial flap failure, and two flaps (0.7%) suffered total flap failure. This manuscript demonstrates that the MAF is a reliable and underutilized flap option with a well-hidden donor scar and a low complication rate. [Display omitted] [ABSTRACT FROM AUTHOR]

Abstract Objective Use of the supraclavicular artery island flap (SCAIF) in head and neck reconstruction has increased in recent years. Limited but improving experience among reconstructive surgeons with the procedure have exposed numerous issues associated with flap success. The objective of this study is to examine the role of flap size on viability. Study Design Retrospective case series. Setting Tertiary Academic Medical Center. Methods Review of patients undergoing SCAIF reconstruction between January 2014 and March 2022 was performed. Flap failure was defined as >50% skin paddle loss. The total flap surface area was examined. Multivariable analysis was performed to evaluate the association of other variables associated with flap failure. Results Eighty‐nine supraclavicular island flaps were reviewed. Mean patient age was 63.2 ± 11.4 years. Fifty‐five (61.2%) were male. Forty‐five flaps (50.6%) were used for the reconstruction of defects of the skin of the neck/face. Twenty‐nine flaps (32.6%) were utilized for defects of the pharynx/oropharynx, and 15 (16.9%) were utilized for oral cavity defects. Flap success rate was 94% (73/89). Flap site was not associated with flap failure (P = .46). Flaps >25 cm2 were 75% more likely to be successful. Multivariable logistic regression to assess the association of flap size in the context of other co‐morbidities indicated flaps >25 cm2 were 3.6 times more likely to succeed regardless of co‐morbidities, and patients with chronic obstructive pulmonary disease (COPD) have a 7‐fold risk of flap failure (odds ratio: 7.3, 1.72‐30.98, P = .007). Conclusion An association with improved flap outcomes and larger skin paddles was observed in this series. The applicability of these observations to smaller flaps and larger series with more surgeons requires further study. Co‐morbidities, particularly, COPD, continue to impact flap outcomes.

Background: Soft tissue reconstruction around ankle and distal third of the leg is challenging due to paucity of the skin around ankle and prominence of lateral and medial malleolus. Lower third of the leg and ankle defects are best reconstructed by a free flap particularly if the defect is larger in size. However small to medium size defects around ankle and distal third of leg, lateral malleolus, medial malleolus and tendoachilles areas can be managed by locoregional flap. Local flaps are also useful in situations where patient is unfit for prolong duration of surgery. With better understanding of vascular anatomy and pre operative localization of perforators many local flaps can be designed for such defects. Commonly used pedicle flaps for ankle and distal third leg includes reverse sural artery flap, posterior tibial artery based perforator flap, peroneal artery perforator based flap, propeller flap, lateral supramalleolar flap, and peroneus brevis muscle flap. However there in no algorithm for their use in these sites. Method: Retrospective analysis of 31 post traumatic patients who underwent reconstruction for small to medium size defects over lateral malleolus, medial malleolus, posterior aspect of heel and tendoachilles area were included in the study. Large defects reconstructed with free flap were excluded from the study. Defects were analyzed in term of site, size of the defect, mode of reconstruction and functional outcome using AOAFS. Result Out of the 31 patients who were eligible, 25 (80.64 %) were men and 6 (19.35%) were women with a mean age 36.41 with SD 1.07. (Range 8-58) years. 83.87 % were less than 50 years. Size of the defect ranged from 4 cm² to 120 cm². Lateral malleolus was involved in 7 cases. Medial malleolus in 10 cases, tendoachilles in 12 cases, intermalleolar area in 2 cases. Small to moderate size defects of lateral malleolar area < 4 cm were reconstructed with peroneus brevis muscle flap (5 cases). Large defects of lateral malleolar area > 4cm were reconstructed with RSA flap (2 cases). Medial malleolus was reconstructed with propeller flap in 3 cases, Posterior tibial artery based perforator flap in 3 cases and Reverse Sural artery flap in 4 cases. Tendoachilles area were reconstructed with RSA flap in 9 cases, peroneal perforator flap in 3 cases. Anterior aspect of ankle resurfaced with lateral supramalleolar flap in 2 cases. The mean follow-up was 8 month. Statistical analysis of functional outcome was done using ANOVA method. There were no statistically significant difference between various methods used for reconstruction of flaps (P= 0.58). Conclusion: Good functional outcome can be achieved with careful selection of flap for small and medium size defect around ankle defect. [ABSTRACT FROM AUTHOR]

IntroductionMusculoskeletal transfer for chest wall tissue defects is a crucial method, and pedicled flaps around the chest wall are preferred in terms of location and simplicity of transfer. These require special care because of complications such as partial necrosis, fistula, wound dehiscence, infection, hematoma and restricted function of the arm or shoulder. However, studies of respiratory function are rare. In the present study, we investigated the complications including respiratory problems after wide resection for malignant chest wall tumors with musculoskeletal pedicle transfer.MethodsA total of 13 patients (15 operations) who underwent wide resection of primary, recurrent, or metastatic malignant chest wall tumors and musculoskeletal pedicle transfer for coverage of tissue defects were enrolled in the present study. A retrospective review of all patients was performed using data collected from hospital records and follow-up information. The complications of musculoskeletal transfer after chest wall wide resection, including respiratory problems, are evaluated.ResultsRib or sternal resection was performed in 12 operations, and only soft tissue resection was performed in 3 operations. Latissimus dorsi (LD) pedicle transfer was performed in 13 operations, and pectoralis major (PM) pedicle transfer was performed in 2 operations; basically, wounds were closed primarily. Surgical complications were observed following 5 of the 15 operations (33.3%). Respiratory complications were seen in 7 of the 15 operations (46.7%). Patients with respiratory complications showed significantly lower preoperative FEV1.0% values than those without respiratory complications (p = 0.0196). Skin resection area tended to be higher in the complication group than in the no complication group (p = 0.104).DiscussionPedicled myocutaneous flap transfers such as LD, PM, and rectus abdominus can be used following multiple resections. After harvesting LD or PM, the wound can be closed primarily for an 8–10-cm skin defect in patients with normal respiratory function. However, for patients with low FEV1.0%, after primary closure of LD or PM transfer for wide soft tissue defects, attention should be paid to postoperative respiratory complications.

Complex scalp defects involving soft and hard tissues pose challenges for plastic surgeons. The solution for each defect must depend on various factors and even the technical development of the infrastructure. We present a case study in which the patient had a significant total frontal defect. The first surgery was a bi-parietal flap as a salvage option to cover the defect. However, aesthetic satisfaction was not achieved. The second surgery used the anterolateral thigh flap to enhance the aesthetic result, and the placement of titanium mesh was an appropriate choice. This case may be an example of how different solutions can lead to variable results and what needs to be considered when dealing with complex scalp defects. [ABSTRACT FROM AUTHOR]

Objective: A transverse ventral preputial island flap is a technique for the repair of fossa navicularis strictures. In the accompanying video, we present the details of our technique for urethral reconstruction with ventral preputial island flap. Patient and surgical procedure: The patient is a 50-year-old male with fossa navicularis stricture secondary to a transurethral resection of the prostate. On pre-operative exam the patient had a fossa navicularis stricture measuring 9 French. He had no evidence of hypospadias or signs of lichen sclerosus. A circumcising incision was created followed by a ventral urethrotomy down to healthy urethral mucosa. A preputial flap of the appropriate dimensions was liberated and then transposed, inverted and secured into the urethral defect. Meatus is matured to 30 Fr. Suprapubic tube and urethral stent were placed. Results: There were no operative or immediate post-operative complications. Patient was discharged on the same day. His urethral stent was removed at his one-week post-operative appointment. On subsequent follow up the patient remains satisfied with cosmesis and function and has an easily directed urinary stream. Previously reported outcomes following this procedure reveals this technique to be safe and successful. Conclusions: A transverse ventral preputial island flap is a safe and technically feasible technique for the management of fossa navicularis strictures utilizing an often-available local cutaneous flap. While this flap should not be used in the presence of lichen sclerosus or when blood supply to the distal penile skin is questionable, in an appropriately selected patient, it can provide an effective surgical solution with good functional and aesthetic outcomes.

The aim of this article is to describe an island flap, harvested from the inguinal fold, which can be used for vulvar reconstruction: the inguinal fold island flap (IFI flap). IFI flap is indicated for reconstruction of defects of vaginal vestibule and labia minora and it could be raised bilaterally safeguarding regional symmetry and avoiding vaginal introitus or urethral distortion. This flap has been utilized to reconstruct defects after vulvar melanoma and squamous cell carcinoma resections and in one case to restore vaginal vestibule anatomy in a revision surgery in a transgender woman. IFI flap is an example of an "aesthetic/functional" reconstruction which could be proposed to younger patients too. [ABSTRACT FROM AUTHOR]

Objective To observe the effect of retroauricular pedicle flap on repairing skin defect after auricle skin tumor resection. Methods From June 2019 to June 2021, a total of 8 patients with auricle skin tumor were admitted to our hospital. The skin defect left after intraoperative expanded resection of the tumor was repaired with retroauricular pedicle flap. Results All the wounds healed after operation with slight scar along with good color and texture. The auricle shape was satisfactory after more than 6 months of follow-up. Conclusion The auricle skin defect can be repaired with retroauricular pedicle flap after auricle skin tumor resection. The operation is simple, effective and worthy of clinical application.

The reconstruction of soft tissue defects in the foot and ankle remains a big challenge due to the anatomical characteristics of this area. This study evaluated the long-term effectiveness of covering by lateral supramalleolar flap in patients with soft tissue defects around the ankle and foot. We conducted a retrospective study from January 2017 to December 2020 at the Hospital for Traumatology and Orthopedics, Ho Chi Minh City, Vietnam. Data about patients' characteristics, detailed injuries, perioperative information, intraprocedural dossier, and complications of this method were recorded and analyzed. There were 31 male and 17 female patients, with an average age of 39.8 (ranging from 11 to 77) years. The skin defects ranged from 8 cm2 to 120 cm2. The blood supply for the flap included a mixed-flow pattern (n = 30) and retrograde flow (n = 18). The success rate was 94%. Forty-two patients had been successfully covered, five patients had partial flap necrosis (in which two cases needed skin graft afterwards and three cases got spontaneous healing), only one patient had total flap necrosis. In conclusion, the lateral supramalleolar flap can cover the soft tissue of ankle and foot defects in both mixed-blood supply pattern or retrograde pattern with high success rates. However, the risk of venous congestion should be considered, particularly when using the retrograde pattern flap. [ABSTRACT FROM AUTHOR]

The presented study was designed to compare the clinical features and the surgical outcomes of three techniques, such as the conjunctival pedicle flap (CPF), platelet-rich fibrin membrane graft (PRFMG), and nictitating membrane flap (NMF) applied after lamellar keratectomy to treat corneal sequestrum in cats. The postsurgical outcomes, complications, and recurrence rate of the lesions in 31 eyes of a total of 30 cats of different ages, breeds, and gender diagnosed with corneal necrosis were evaluated in the study. After partial keratectomy, patients were divided into three groups, each containing ten animals. Perioperative findings of all cases that underwent CPF, PRFMG, and NMF applications, including postsurgical complications, were evaluated. All patients were regularly monitored. Advantages and disadvantages were noted for all three techniques during and after the surgery. Despite long-term medical treatment with CPF (3-4 months), varying degrees of permanent fibrosis partially impairing vision developed in the related defect area, but no recurrence was observed in eyes that could not be fully keratectomy. In all cases with PRFMG, it was determined that the corneal granulation tissue disappeared completely within 5-6 weeks and the corneal transparency increased by 70% within 1.5-2 months, while recurrence developed in 2 cases. In eyes treated with NMF method, although tectonic support to the cornea and no additional tissue transplantation to accelerate the healing of the defect area was performed, the recovery period was fast and the duration of medical treatment applied to reduce or completely resolve the corneal fibrosis after surgery was very short. A rapid corneal restoration was determined in cats treated with the NMF method. Anatomical outcome was evaluated as positive in all methods. Both fast and satisfactory cosmetic appearance was achieved in PRFMG and NMF techniques. The results of this study proved that all three techniques are suitable for treating corneal necrosis in cats because of their practicality, relative effortlessness and non-invasiveness.

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To determine the impact of the buccal envelope flap and pedicle design on the post-operative outcome and quality of life following lower third molar surgery (QoL). A randomized case-control clinical study was carried out from September 2017 to September 2019. In this study, a total number of 50 patients with mandibular third molar impaction underwent surgical removal of the same using buccal envelope flap (group A) and pedicle flap (group B). The patients were assessed postoperatively for pain, swelling, trismus, wound dehiscence, dry socket, and quality of life for one month. In terms of pain, swelling, and trismus, there was no statistical difference between the two groups (p > 0.05). However, there was a statistically significant difference found in group B (pedicle flap) in terms of wound dehiscence, dry socket, and quality of life (p < 0.05). The pedicle flap demonstrates fewer incidences of wound dehiscence, dry socket, and a better quality of life when compared to the envelope flap. [Display omitted] [ABSTRACT FROM AUTHOR]

Abstract The muzzle region of dogs contains various composite tissues, which are challenging to recreate during reconstruction. Small or moderate facial/nasal defects can be closed primarily or left for second‐intention healing. However, larger defects require the application of composite tissue or labial advancement flaps. Axial pattern flaps based on the caudal auricular artery, superficial temporal artery (STA), angularis oris artery, and other cutaneous arteries have been reported. In our case, we aim to report the reconstruction of a large composite defect of the rostral and dorsal nasal regions in a dog using an augmented, axial myocutaneous flap based on bilateral STAs. This is a clinical report on a spayed female mixed‐breed dog (age, 7 years; weight, 15 kg), in which a large‐scale nasal–facial composite tissue defect was surgically reconstructed using an axial myocutaneous flap based on bilateral STA branches. A delay technique was applied to prefabricate the flap to enrich the blood supply. New nostrils were created on a folded, rostral hard palate. As a result, the axial tube rotational flap was successfully transferred. The use of delay technique for prefabricating the tube flap optimized its size and survival. In addition to the folded rostral hard palate, the flap fully closed the defects on the face and nose. Functional and cosmetic outcomes were satisfactory, with minimal donor‐site morbidity. In, conclusion, a large‐scale nasal–facial defect in a dog was successfully reconstructed using an augmented tube pedicle flap based on the bilateral STAs, which may, thus, be used to repair very large facial‐nasal defects in dogs.

Verrucous hyperplasia (VH) is a rare and potentially malignant exophytic oral mucosal lesion with a verrucous or papillary surface. VH has a tendency to transform into its malignant counterpart, verrucous carcinoma, which is clinically indistinguishable, yet histologically variable. The most common site of predilection is the buccal mucosa and VH more prevalent in patients with habits of areca nut chewing or smoking. A biopsy of the lesion with the surrounding normal mucosa and adequate depth should be performed to histopathologically to diagnose the condition and provide treatment management accordingly. The present study describes the case of a 37-year-old male with VH of the buccal mucosa that was successfully managed by surgical excision and reconstruction using the buccal fat pad (BFP). BFP was used due to its higher vascularity, its proximity to the donor site and to provide less scar contracture. The patient was followed up regularly and the surgical site was health with uneventful healing and complete mucolisation. [ABSTRACT FROM AUTHOR]

Treatment of gingival recession is a prime concern due to an increase in hypersensitivity and high esthetic demands. There are various proposed treatment options for treating this mucogingival defect. Treating Miller's Class III recession is definitely a true challenge for the periodontists. Defects adjacent to the edentulous region, present with additional difficulty due to collapse of ridge postextraction, leading to the gingival defect. Here is a case report, presenting Class III recession defect adjacent to the edentulous site of the lower left second premolar, which was treated with the help of lateral pedicle flap obtained from the adjacent edentulous area along with subepithelial connective tissue graft, a bilaminar technique. [ABSTRACT FROM AUTHOR]

Background: In the present study, we have shared our experience in managing head neck cancers, especially the oral malignancies, during the crisis of COVID 19. Materials and methods: Patients with oral cancers underwent pedicle/local flaps and free flaps reconstruction based on the availability of intensive care unit and comorbidities of the patients. The clinical outcomes were compared at the end of one week, one month, and three months after the primary surgery. Results: Pedicle/local flaps were used in 25 cases and radial/fibular free flaps were used in 8 cases for the reconstruction of soft tissue defects. Patients with pedicle flap reconstruction had better clinical outcomes, including lesser ICU stay as compared to free flaps. Conclusion: Pedicle flap can be a valid alternative to the free flap for the soft tissue reconstruction in advanced oral malignancies during the COVID pandemic period in the Indian subcontinent, especially with limited infrastructure of the hospitals. [ABSTRACT FROM AUTHOR]

The presented study was designed to compare the clinical features and the surgical outcomes of three techniques, such as the conjunctival pedicle flap (CPF), platelet-rich fibrin membrane graft (PRFMG), and nictitating membrane flap (NMF) applied after lamellar keratectomy to treat corneal sequestrum in cats. The postsurgical outcomes, complications, and recurrence rate of the lesions in 31 eyes of a total of 30 cats of different ages, breeds, and gender diagnosed with corneal necrosis were evaluated in the study. After partial keratectomy, patients were divided into three groups, each containing ten animals. Perioperative findings of all cases that underwent CPF, PRFMG, and NMF applications, including postsurgical complications, were evaluated. All patients were regularly monitored. Advantages and disadvantages were noted for all three techniques during and after the surgery. Despite long-term medical treatment with CPF (3-4 months), varying degrees of permanent fibrosis partially impairing vision developed in the related defect area, but no recurrence was observed in eyes that could not be fully keratectomy. In all cases with PRFMG, it was determined that the corneal granulation tissue disappeared completely within 5-6 weeks and the corneal transparency increased by 70% within 1.5-2 months, while recurrence developed in 2 cases. In eyes treated with NMF method, although tectonic support to the cornea and no additional tissue transplantation to accelerate the healing of the defect area was performed, the recovery period was fast and the duration of medical treatment applied to reduce or completely resolve the corneal fibrosis after surgery was very short. A rapid corneal restoration was determined in cats treated with the NMF method. Anatomical outcome was evaluated as positive in all methods. Both fast and satisfactory cosmetic appearance was achieved in PRFMG and NMF techniques. The results of this study proved that all three techniques are suitable for treating corneal necrosis in cats because of their practicality, relative effortlessness and non-invasiveness. [ABSTRACT FROM AUTHOR]

Background  Gynecological reconstruction is difficult, particularly in cases with recurrence and received previous surgeries and/or radiotherapy and necessitate secondary reconstruction. Perforator flaps can preserve other donor sites for potential later reconstruction, and they also can be better tailored to the defect. We hypothesized that the use of perforator-based flaps can better restore the defect with less complications. Methods  A retrospective review was conducted of all patients who underwent vulvar–perineum reconstruction between 2011 and 2018 by the senior author, and oncologic and reconstructive outcomes and complications were analyzed. Results  Thirty-three patients underwent 55 soft tissue reconstructions for vulvar–perineum defects during the study period. The mean follow-up time was 27.6 ± 28.9 months. Squamous cell carcinoma was the most common cancer (45.5%). For 11 patients (33.3%), the procedures were performed for the treatment of recurrent cancer. The average defect size was 39.8 ± 34.3 cm 2. The overall survival rate was 90.3%. Profunda artery perforator flaps were the most commonly applied flap for reconstruction in both the primary and recurrent groups. Poor wound healing was the most common complication which occurred in 10 of the 55 flaps (18.2%). Perforator flaps presented fewer complications than myocutaneous flaps or traditional random flaps. Similarly, Island pedicle flap design also presented fewer complications than traditional rotation flaps. With proper reconstruction, previous surgery or radiotherapy did not contribute to an increase in complications. Conclusion  In our experience, perforator flaps can provide satisfactory reconstruction for perineum reconstruction with low postoperative complications while preserving other donor sites in the event of disease recurrence for repeat resection and reconstruction. Previous surgery or radiotherapy did not increase the complications or preclude its usage. A redefined reconstructive ladder was created to help selecting the best state-of-the-art technique for reconstruction to achieve better results. [ABSTRACT FROM AUTHOR]

Large upper central chest wall defects are a reconstructive challenge. The commonly described flaps for this area do not provide very large skin paddle, and free tissue transfer remains the only option for large skin defects. Supraclavicular flap as a local flap is widely used for head and neck reconstruction and has been described for upper chest wall defects earlier. We have used nonislanded supraclavicular flap for reconstruction of two cases of large chest wall defects, which would otherwise need free tissue transfer, single flap in one case and bilateral flaps in the other. It is easy to do and has minimal morbidity. Supraclavicular flap offers a simple solution for large skin defects of the upper central chest wall and is especially useful in patients with high-operative risk and guarded prognosis.

The development of a tracheocutaneous fistula (TCF) is a well-documented complication after tracheostomy, especially in chronic morbid patients, in whom tubes or cannulas are left in place over time, or in irradiated patients. Surgical treatments are therefore needed which range from simple curettage and dressings to local skin flaps, muscle flaps and, in the more complex cases, microsurgical free tissue transfers. We present a novel combined technique used to successfully treat recurrent TCFs in irradiated patients, involving a superiorly based turnover fistula flap and a sternocleidomastoid transposition flap.

Introduction: In Japan, transgender individuals have historically had limited therapeutic options, prompting many to seek gender-affirming surgeries in private or foreign clinics because of restricted access to public hospitals. This has led to challenges for patients undergoing surgery., Case Presentation: A transgender man underwent surgery at a private clinic and experienced recurrent complications. Subsequent examination at another clinic and our hospital revealed limited medical records, complicating our understanding of this case. After a detailed investigation, the urethrocutaneous and urethrovaginal fistulas were identified and addressed by joint urologists and plastic surgeons, resulting in no recurrence after 1 year., Conclusion: This case underscores the importance of thorough preoperative assessment with a flexible mindset, emphasizing the need to avoid being misled by inadequate records or appearances in complication management of gender-affirming surgery. Collaborative efforts among healthcare professionals based on comprehensive evaluations lead to safer complication treatments., Competing Interests: The authors declare no conflict of interest., (© 2024 The Author(s). IJU Case Reports published by John Wiley & Sons Australia, Ltd on behalf of Japanese Urological Association.)

Objective: Use of the supraclavicular artery island flap (SCAIF) in head and neck reconstruction has increased in recent years. Limited but improving experience among reconstructive surgeons with the procedure have exposed numerous issues associated with flap success. The objective of this study is to examine the role of flap size on viability., Study Design: Retrospective case series., Setting: Tertiary Academic Medical Center., Methods: Review of patients undergoing SCAIF reconstruction between January 2014 and March 2022 was performed. Flap failure was defined as >50% skin paddle loss. The total flap surface area was examined. Multivariable analysis was performed to evaluate the association of other variables associated with flap failure., Results: Eighty-nine supraclavicular island flaps were reviewed. Mean patient age was 63.2 ± 11.4 years. Fifty-five (61.2%) were male. Forty-five flaps (50.6%) were used for the reconstruction of defects of the skin of the neck/face. Twenty-nine flaps (32.6%) were utilized for defects of the pharynx/oropharynx, and 15 (16.9%) were utilized for oral cavity defects. Flap success rate was 94% (73/89). Flap site was not associated with flap failure ( P  = .46). Flaps >25 cm 2 were 75% more likely to be successful. Multivariable logistic regression to assess the association of flap size in the context of other co-morbidities indicated flaps >25 cm 2 were 3.6 times more likely to succeed regardless of co-morbidities, and patients with chronic obstructive pulmonary disease (COPD) have a 7-fold risk of flap failure (odds ratio: 7.3, 1.72-30.98, P  = .007)., Conclusion: An association with improved flap outcomes and larger skin paddles was observed in this series. The applicability of these observations to smaller flaps and larger series with more surgeons requires further study. Co-morbidities, particularly, COPD, continue to impact flap outcomes., Competing Interests: There are no financial interests or conflicts of interest to disclose., (© 2024 The Author(s). OTO Open published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

The muzzle region of dogs contains various composite tissues, which are challenging to recreate during reconstruction. Small or moderate facial/nasal defects can be closed primarily or left for second‐intention healing. However, larger defects require the application of composite tissue or labial advancement flaps. Axial pattern flaps based on the caudal auricular artery, superficial temporal artery (STA), angularis oris artery, and other cutaneous arteries have been reported. In our case, we aim to report the reconstruction of a large composite defect of the rostral and dorsal nasal regions in a dog using an augmented, axial myocutaneous flap based on bilateral STAs. This is a clinical report on a spayed female mixed‐breed dog (age, 7 years; weight, 15 kg), in which a large‐scale nasal–facial composite tissue defect was surgically reconstructed using an axial myocutaneous flap based on bilateral STA branches. A delay technique was applied to prefabricate the flap to enrich the blood supply. New nostrils were created on a folded, rostral hard palate. As a result, the axial tube rotational flap was successfully transferred. The use of delay technique for prefabricating the tube flap optimized its size and survival. In addition to the folded rostral hard palate, the flap fully closed the defects on the face and nose. Functional and cosmetic outcomes were satisfactory, with minimal donor‐site morbidity. In, conclusion, a large‐scale nasal–facial defect in a dog was successfully reconstructed using an augmented tube pedicle flap based on the bilateral STAs, which may, thus, be used to repair very large facial‐nasal defects in dogs. A large‐scale nasalfacial defect in a dog was successfully reconstructed using an augmented tube pedicle flap based on the bilateral STAs, which may, thus, be used to repair very large facial‐nasal defects in dogs. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the effectiveness and long-term outcomes of free and pedicled, expanded deltopectoral flaps with perforation of the internal thoracic artery to repair facial scars. This retrospective review was of 37 patients who presented between June 2013 and June 2019 with various types of facial scar. Ten patients received a free expanded deltopectoral flap and 27 a pedicled, expanded deltopectoral flap. During the stage-one operation, the expander was implanted into the deltopectoral area and fully expanded by normal saline injection. In stage two, the facial lesions were incised, and the free or pedicled flap transferred to reconstruct the defect. Flap necrosis did not occur in the 10 patients treated with free flaps. Two patients need to have the pedicle trimmed three months after surgery because it had become bloated. Distal necrosis occurred in five of 27 patients who received a pedicled, expanded deltopectoral flap. Healing by conservative treatment was noted in two cases and healing after skin grafting was documented in the other three. All 37 patients achieved satisfactory results. A pedicled, expanded deltopectoral flap appears to be a reliable and safe option for the treatment of facial scars. [ABSTRACT FROM AUTHOR]

The purpose of the study was to evaluate the influence of interstitial postoperative brachytherapy for the vitality and quality of flaps used for reconstruction of tissue defects after head and neck cancer salvage resection. We aimed at presenting six consecutive patients with recurrent squamous cell carcinoma in head and neck region who underwent salvage surgery and tissue reconstruction with a regional or free flap followed by brachytherapy. Reconstruction was performed with a free radial forearm flap in 2 cases, with a free thigh flap in 2 cases, and with a myocutaneous lateral upper arm flap in the next 2 cases. In all patients, pulsed-dose-rate brachytherapy was used with a median value of 0.7 Gy (range 0.6–0.8 Gy) per pulse and a median total dose of 20 Gy (range 20–40 Gy). In the analyzed group, there were no serious wound and flap complications after brachytherapy. In one case, peripheral skin necrosis was noticed. No revision surgery was needed but only surgical debridement of the necrotic margins. All wounds healed within 14 days after surgery as well as donor sites which healed within 4 weeks. Based upon our data, pulsed-dose-rate brachytherapy seems to be a safe option that can be performed at the site of reconstruction in immediate postoperative period with minimal wound complications and with no impact on flap survival. Further clinical study based on larger patient series is needed to present statistically proven results. [ABSTRACT FROM AUTHOR]

Background: To describe a technique in which the anterior jugular vein is preserved in the infrahyoid myocutaneous flap (IHMCF) to augment skin paddle venous drainage. Methods: From April 2018 to December 2019, 14 patients with primary oral cancer underwent radical resection and IHMCF reconstruction. Three‐dimensional reconstruction of the anterior jugular vein was used to assess the venous drainage of the skin paddle preoperatively. The anterior jugular vein was preserved during dissection of the flap. Healing of the recipient and donor sites was observed. Results: Total flap necrosis occurred in one patient and marginal skin paddle necrosis occurred in one patient. No flap complications occurred in the other 12 patients. Conclusion: This new approach to augment venous drainage of the IHMCF appears to be effective for decreasing risk of flap necrosis. [ABSTRACT FROM AUTHOR]

Background and objective. Coverage defects in the upper limb have significant aesthetic and functional implications. Mostly this defects are treated by microsurgery, however in some institutions with limited economical resources or unavailability of this area, distant flaps become an important option for reconstruction. The vertical pattern abdominal flap is our first choice for the coverage of these defects. Methods. Retrospective study of cases with upper limb coverage defects treated with vertical pattern abdominal flap at the San Jorge de Pereira Hospital (Colombia) between 2016 and 2020. Results. Ten vertical pattern abdominal flaps were performed, all in male patients, with a mean age of 33.3 years. The etiology of the defects was electrical burn in 7 cases, traffic accident in 2 and blunt trauma in 1. In 9 patients an upper base flap was performed and in 1 a lower base flap, all of them under general anesthesia with a surgical time between 90 and 120 minutes. Adequate coverage was obtained in 100% of the cases, with suture dehiscence in flap area as the only complication. Conclusions. Vertical pattern abdominal flap is a versatile, reproducible, and safe option, useful in absence of resources or the possibility of performing microsurgery, Currently, it is our first option in upper limb covering defects, allowing to obtain satisfactory results with low complication rate. [ABSTRACT FROM AUTHOR]

Introduction: Musculoskeletal transfer for chest wall tissue defects is a crucial method, and pedicled flaps around the chest wall are preferred in terms of location and simplicity of transfer. These require special care because of complications such as partial necrosis, fistula, wound dehiscence, infection, hematoma and restricted function of the arm or shoulder. However, studies of respiratory function are rare. In the present study, we investigated the complications including respiratory problems after wide resection for malignant chest wall tumors with musculoskeletal pedicle transfer., Methods: A total of 13 patients (15 operations) who underwent wide resection of primary, recurrent, or metastatic malignant chest wall tumors and musculoskeletal pedicle transfer for coverage of tissue defects were enrolled in the present study. A retrospective review of all patients was performed using data collected from hospital records and follow-up information. The complications of musculoskeletal transfer after chest wall wide resection, including respiratory problems, are evaluated., Results: Rib or sternal resection was performed in 12 operations, and only soft tissue resection was performed in 3 operations. Latissimus dorsi (LD) pedicle transfer was performed in 13 operations, and pectoralis major (PM) pedicle transfer was performed in 2 operations; basically, wounds were closed primarily. Surgical complications were observed following 5 of the 15 operations (33.3%). Respiratory complications were seen in 7 of the 15 operations (46.7%). Patients with respiratory complications showed significantly lower preoperative FEV1.0% values than those without respiratory complications ( p  = 0.0196). Skin resection area tended to be higher in the complication group than in the no complication group ( p  = 0.104)., Discussion: Pedicled myocutaneous flap transfers such as LD, PM, and rectus abdominus can be used following multiple resections. After harvesting LD or PM, the wound can be closed primarily for an 8-10-cm skin defect in patients with normal respiratory function. However, for patients with low FEV1.0%, after primary closure of LD or PM transfer for wide soft tissue defects, attention should be paid to postoperative respiratory complications., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Asanuma, Tsujii, Hagi, Nakamura, Uchiyama, Adachi, Nakata, Kataoka and Sudo.)

Large upper central chest wall defects are a reconstructive challenge. The commonly described flaps for this area do not provide very large skin paddle, and free tissue transfer remains the only option for large skin defects. Supraclavicular flap as a local flap is widely used for head and neck reconstruction and has been described for upper chest wall defects earlier. We have used nonislanded supraclavicular flap for reconstruction of two cases of large chest wall defects, which would otherwise need free tissue transfer, single flap in one case and bilateral flaps in the other. It is easy to do and has minimal morbidity. Supraclavicular flap offers a simple solution for large skin defects of the upper central chest wall and is especially useful in patients with highoperative risk and guarded prognosis. [ABSTRACT FROM AUTHOR]

The development of a tracheocutaneous fistula (TCF) is a well-documented complication after tracheostomy, especially in chronic morbid patients, in whom tubes or cannulas are left in place over time, or in irradiated patients. Surgical treatments are therefore needed which range from simple curettage and dressings to local skin flaps, muscle flaps and, in the more complex cases, microsurgical free tissue transfers. We present a novel combined technique used to successfully treat recurrent TCFs in irradiated patients, involving a superiorly based turnover fistula flap and a sternocleidomastoid transposition flap. [ABSTRACT FROM AUTHOR]

Introduction A 44-year-old man was presented with chronic discharging multiple perianal fistula and squamous cell carcinoma of the left buttock. Report The patient was subjected to wide local excision of the entire left gluteal and adjacent sacral regions and reconstruction with extended island inferior gluteal artery based V–Y myocutaneous advancement flap. Result and Conclusion Extended island inferior gluteal based V–Y flap can be a good option for extensive defects involving the gluteal region and the sacrum.

Background: This study demonstrates the anatomy of the pedicled temporal artery posterior auricular skin (TAPAS) flap, its variable arc of rotation based on stepwise dissection, and case reports demonstrating clinical use. This flap provides excellent color match and ultrathin tissue for targeted reconstruction of small‐ to medium‐sized facial subunit defects. Methods: Twenty‐six cadaver dissections were performed. The authors measured the reach and rotation limits of the flap in a pedicled fashion depending on a stepwise approach for vascular pedicle dissection. Two clinical cases demonstrating maximum arc of rotation are seen. Results: The pedicled TAPAS flap maximal rotation limits allow for reconstruction of facial subunits encompassing nearly the entire ipsilateral face. No venous congestion, wound complications, or partial/total flap loss were encountered with extreme clinical applications. Conclusion: The pedicled TAPAS flap has extensive versatility for reconstruction of a variety of facial subunit defects. The flap also has, in theory, multiple applications for intraoral reconstruction. [ABSTRACT FROM AUTHOR]

Objectives: To determine if the volume of buccal fat, ascertained by computed tomography (CT) scanning, would correspond to surface area and reach (length and width) of the flap intraoperatively to aid in the reconstruction of selected skull base defects.Methods: Cadaveric study of five specimens, 10 sides. Methods CT imaging and evaluation using the Osirix 9 software (Pixmeo; Bernex, Switzerland). of cadaveric heads to calculate the volume of the buccal fat bilaterally. The flap was then harvested endoscopically. Measurements were taken. Two heads were also dissected via a transfacial approach.Results: The volume of the buccal fat pad (BFP) as well as the maximum length and width of the endoscopically harvested flap were documented. There was a positive correlation shown between the calculated volume of the BFP based on CT imaging and the dissected length and width of the flap (Pearson correlation, r = 0.83 and r = 0.80, respectively). The transfacial dissection demonstrated the lobes of the BFP well, showing that most of the endoscopic mobilization of the BFP was limited to the posterior lobe, in particular to the temporalis and pterygoid components, with minimal displacement of the superficial components. This minimized the risk of visibly hollowing the buccal fullness.Conclusion: Preoperative calculation of the CT-based volume of the BFP correlates positively with the intraoperative maximum reach of the flap for both length and width. Whereas the volume may be lower in some instances, the BFP would still have adequate reach to provide coverage for the lower and mid-clival region in most patients.Level Of Evidence: NA. Laryngoscope, 130:1670-1673, 2020. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the outcomes of younger and older patients with palatal cancer undergoing reconstruction using the pedicled facial-submental artery island flap (FSAIF) following cancer ablation. Fifty-eight patients with palatal squamous cell carcinoma (SCC) were divided into two age groups: ≤60 years (n = 31) and >60 years (n = 27). By clinical SCC stage, 6.4%, 83.9%, and 9.7% of the younger group and 3.7%, 85.2%, and 11.1% of the older group were stage I, II, and III, respectively. The incidence of comorbid conditions was 35.5% (11/31) in those ≤60 years and 137.0% (37/27) in those >60 years. Brown class II maxillary defects (four class IIa, 44 class IIb, three class IIc, and seven class IId) were repaired using FSAIFs following cancer ablation. There were two flap failures; thus the success rate was 96.6%. Significant differences in mean age and the incidence of comorbid conditions were evident between the groups. No significant differences in TNM stage, maxillary defect classification, flap size, overall flap survival, rates of local and general complications, or survival status was evident between the groups. The FSAIF is a reliable and safe method for repairing Brown class II maxillary defects following cancer ablation, particularly in older patients. [ABSTRACT FROM AUTHOR]

Objective: Predictable coverage of multiple adjacent gingival recessions (MAGRs) is a major challenge for clinicians. Although several surgical techniques have been proposed to treat MAGR, it is still unclear as to what extent the proposed approaches may lead to predictable root coverage. The aim of this article is to identify the predictability of the available surgical techniques used to achieve complete root coverage (CRC) of Miller Class I, II, and III MAGRs. Method and Materials: A search of the PubMed database was performed. Additional hand searching and a search for gray literature were also conducted. Due to the heterogeneity of the data, no meta-analysis could be performed. Results: The search resulted in the selection of 16 publications analyzed in this review. In Miller Class I and II MAGRs, the coronally advanced flap (CAF) and the modified coronally advanced flap (MCAF) yielded a CRC ranging from 74.6% to 89.3% and a mean root coverage (MRC) ranging from 91.5% to 97.27% at 6 to 12 months following surgery. In Miller Class I and II recessions, the results obtained with MCAF were maintained for up to 5 years (CRC ranging from 35% to 85.1%), as indicated by two studies. One study has indicated that MCAF + connective tissue grafting (CTG) may improve the long-term stability of CRC compared with MCAF (35% CRC without CTG vs 52% CRC with CTG). In Miller Class I and II MAGRs, the use of CTG in conjunction with CAF, MCAF, coronally positioned pedicle (CPP), double pedicle graft (DPG), or the supraperiosteal tunnel technique yielded higher CRC or MRC than with bioabsorbable membranes, acellular dermal matrix (ADM), or platelet-rich fibrin (PRF). In Miller Class III MAGRs, the modified coronally advanced tunnel (MCAT) and CTG with and without an enamel matrix derivative resulted in 38% CRC and in 82% to 83% MRC, respectively. Conclusion: The present findings indicate that in Miller Class I and II MAGRs, CAF or MCAF with or without CTG may lead to predictable CRC; the CRC obtained with MCAF were maintained over a period of 5 years; the use of CTG appears to improve the long-term stability of the MCAF; and the use of CTG in conjunction with CAF, MCAF, CPP, DPG, or the supraperiosteal tunnel technique appear to yield higher CRC or MRC than the use of bioabsorbable membranes, ADM, or PRF. Also, MCAT plus CTG appears to represent a valuable technique for the treatment of Miller Class III MAGRs. [ABSTRACT FROM AUTHOR]

Root coverage has become an important aspect of periodontal plastic surgery. It is a challenge in the presence of a high frenal pull and inadequate attached gingiva. This article reports two such cases of gingival recession, which have been treated with double lateral sliding bridge flaps. The main advantages of this technique are that it doesn't require a separate frenectomy procedure and it can be used to cover multiple gingival recession defects, without a second surgical site. The two treated cases demonstrated adequate root coverage and increase in width of the attached gingiva at 6 months follow-up. [ABSTRACT FROM AUTHOR]

Labial mucosal fenestration of the root apex is an uncommon occurrence. An unusual case involving a maxillary right first premolar is described. When presented, the tooth was nonvital with the buccal root apex readily seen through a soft tissue and bone fenestration. Conventional endodontic treatment with gutta percha failed to resolve the problem. Periodontal surgery with a laterally positioned pedicle flap was thus scheduled. At the 1-month recall, complete healing was evident in the surgical site, and the fenestrated area of the maxillary right first premolar was filled with healthy mucosal tissue. One-year postoperatively, the mucosa remained covered, and there was radiographic evidence of bone infilling in the periapical region. [ABSTRACT FROM AUTHOR]