BACKGROUND: Penile cancer patients with advanced metastatic disease in the inguinal region present a therapeutic challenge. This study assesses the long-term viability of tensor fascia lata (TFL) flap for inguinal reconstruction after inguinal lymphadenectomy in metastatic penile cancer patients. MATERIAL AND METHODS: We herein report eight cases of advanced penile cancer utilizing a TFL flap for reconstructing defects in the inguinal region. Demographic characteristics, perioperative findings and outcome of the patients were evaluated. RESULTS: Patients were followed up for 1-35 months. The mean age of patients included in this study was 58.75 years. Six out of eight patients had a favorable prognosis. The strong vascularity of the TFL flap enables excellent coverage, which can reduce the rate of ischemia and necrosis of the flap. No serious complications occurred in all cases during the perioperative period. One patient developed partial flap necrosis, which required debridement, whereas one patient underwent distal wound dehiscence which resolved with routine wound care. CONCLUSIONS: Our experience demonstrates the versatility and effectiveness of the TFL flap in addressing reconstruction of defects following inguinal lymph node dissection among patients with advanced penile cancer.

• Keywords
• advanced penile cancer, inguinal lymph node dissection, tensor fascia lata flap,
• MeSH
• Surgical Flaps * MeSH
• Adult MeSH
• Fascia Lata transplantation   MeSH
• Middle Aged MeSH
• Humans MeSH
• Lymph Node Excision MeSH
• Penile Neoplasms * surgery   MeSH
• Aged MeSH
• Plastic Surgery Procedures * methods   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Publication type
• Journal Article MeSH

The chronic venous disease covers a wide spectrum of venous disorders that are characterized by severely impaired blood return that primarily affects veins in the lower extremities. Morphological and functional abnormalities of the venous system led to chronic venous insufficiency (CVI), and present as leg heaviness/achiness, edema, telangiectasia, and varices. The term 'chronic venous insufficiency' (CVI) refers to a disease of greater severity. Venous dysfunction is associated with venous hypertension and is associated with venous reflux due to poorly functioning or incompetent venous valves, which ultimately reduces venous return, leading to a cascade of morphological, physiological, and histologic abnormalities such as blood pooling, hypoxia, inflammation, swelling, skin changes (lipodermatosclerosis), and in severe cases, venous leg ulcers (VLU). This review summarizes recent knowledge about the aetiology, risk factors, and pathophysiology of VLU and compared the possibilities of their treatment.

• Keywords
• chronic venous insufficiency, compression therapy, therapy, venous leg ulcers, wound coverage,
• Publication type
• Journal Article MeSH

INTRODUCTION: Lower extremity wounds have always been a challenge for the reconstructive surgeons. Free perforator flaps are considered to be the best option for this problem but require the complexity of microsurgery. So, pedicled perforator flaps have emerged as an alternative option. PATIENTS AND METHODS: Prospective study was conducted in 40 patients with traumatic soft tissue defects in the leg and foot. The free flaps included the anterolateral thigh flap (ALT) and medial sural artery perforator flap (MSAP). In pedicled perforator flaps group, 10 cases were designed as propeller flaps while the other 10 flaps were designed as perforator plus flaps. RESULTS: Free flaps were mainly used for large-sized defects; we had one case of partial flap loss and one case of complete flap necrosis. MSAP flap was the first option for coverage of large-sized defects on foot and ankle as it is a thin and pliable flap, while ALT flap was used for coverage of larger defects on the leg. Pedicled perforator flaps were used mainly for small to medium-sized defects, especially in the lower third of the leg; we had three cases of flap loss in propeller flap design while we had no cases of flap loss in perforator plus flap. CONCLUSION: Perforator flaps have become a reasonable solution for soft tissue defects of the lower extremity. Careful assessment of the dimensions, location, patient comorbidities, availability of surrounding soft tissue and presence of adequate perforators are mandatory for proper perforator flap selection.

• Keywords
• anterolateral thigh flap, medial sural artery perforator flap, perforator flap, perforator plus flap, propeller flap,
• MeSH
• Leg blood supply   surgery   MeSH
• Lower Extremity MeSH
• Humans MeSH
• Perforator Flap * blood supply   MeSH
• Postoperative Complications MeSH
• Soft Tissue Injuries * surgery   MeSH
• Prospective Studies MeSH
• Retrospective Studies MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

Treatment of complete loss of skin thickness requires expensive cellular materials and limited skin grafts used as temporary coverage. This paper presents an acellular bilayer scaffold modified with polydopamine (PDA), which is designed to mimic a missing dermis and a basement membrane (BM). The alternate dermis is made from freeze-dried collagen and chitosan (Coll/Chit) or collagen and a calcium salt of oxidized cellulose (Coll/CaOC). Alternate BM is made from electrospun gelatin (Gel), polycaprolactone (PCL), and CaOC. Morphological and mechanical analyzes have shown that PDA significantly improved the elasticity and strength of collagen microfibrils, which favorably affected swelling capacity and porosity. PDA significantly supported and maintained metabolic activity, proliferation, and viability of the murine fibroblast cell lines. The in vivo experiment carried out in a domestic Large white pig model resulted in the expression of pro-inflammatory cytokines in the first 1-2 weeks, giving the idea that PDA and/or CaOC trigger the early stages of inflammation. Otherwise, in later stages, PDA caused a reduction in inflammation with the expression of the anti-inflammatory molecule IL10 and the transforming growth factor β (TGFβ1), which could support the formation of fibroblasts. Similarities in treatment with native porcine skin suggested that the bilayer can be used as an implant for full-thickness skin wounds and thus eliminate the use of skin grafts.

• Keywords
• Bilayer, Chitosan, Collagen, Oxidized cellulose, Polydopamine, Wound healing,
• MeSH
• Mice MeSH
• Nanofibers * MeSH
• Swine MeSH
• Osmium Compounds MeSH
• Inflammation MeSH
• Animals MeSH
• Check Tag
• Mice MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH
• Names of Substances
• chloropentaammineosmium(III) chloride MeSH Browser
• polydopamine MeSH Browser
• Osmium Compounds MeSH

BACKGROUND: Groin flaps have been used as pedicled and free flaps by plastic surgeons for time immemorial. The superficial circumflex iliac artery perforator (SCIP) flap has evolved from the groin flap in which the entire skin territory of the groin flap can be harvested based on the perforators of the superficial circumflex iliac artery (SCIA) and only a part of the SCIA can be taken along with. The pedicled SCIP flap can also be utilized in a large number of cases which is described in our article. PATIENTS AND METHODS: Between January 2022 to July 2022, 15 patients were operated on using the pedicled SCIP flap. Twelve patients were males and 3 patients were females. Nine patients presented with a defect in the hand/forearm, 2 patients had a defect in the scrotum, 2 patients had a defect in the penis, 1 patient had a defect in the inguinal region overlying the femoral vessels and 1 patient had a defect in the lower abdomen. RESULTS: There was a partial loss of one flap and a complete loss of one flap from pedicle compression. The donor site healed well in all cases with no evidence of wound disruption or seroma or hematoma formation. As all the flaps were quite thin, no debulking was needed as an additional procedure. CONCLUSION: The dependability of the pedicled SCIP flap implies that this flap should be used more often in reconstructions in and around the genital area and also in cases of upper limb coverage instead of the classical groin flap.

• Keywords
• SCIP, groin flap, pedicled flap, superficial circumflex iliac artery,
• MeSH
• Iliac Artery MeSH
• Lower Extremity MeSH
• Upper Extremity MeSH
• Humans MeSH
• Free Tissue Flaps * MeSH
• Plastic Surgery Procedures * MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

BACKGROUND: The anterolateral thigh (ALT) flap was described as the fasciocutaneous flap. It can be harvested as a pedicled and/or free flap. Majority of the free flaps are harvested as a fasciocutaneous flap. Their use in head and neck reconstruction and limb trauma is well established. Apart from these advantages, this flap has various applications which are less utilized. ALT flap can be used as a myocutaneous flap along with vastus lateralis muscle. When muscle and fasciocutaneous flaps are required, both can be harvested as a chimeric flap which can cover two different regions of the wound. Moreover, harvest of the pedicled flap procedure is less time-consuming than that of a free flap. Since it has a long vascular pedicle, when used as pedicled flap, it can reach up to the gluteal region. To evaluate these less applied advantages of pedicled ALT flap, our study was undertaken. This study aimed to evaluate the efficiency of ALT flap in terms of the surface area of coverage, arc of rotation and the advantages of including vastus lateralis muscle as part of the flap. METHODS: A retrospective record analysis of all pedicled ALT flap reconstruction of trochanteric, upper thigh, gluteal and flank regions from 2016 to 2018 was undertaken; 7 patients with 8 defects were included. RESULTS: All the flaps healed successfully. There was no major necrosis of the flap and minor complications like wound gapping were found in three patients. CONCLUSION: The ALT-vastus lateralis flap dimensions can be very large and can be easily harvested in a very short time. Vastus lateralis muscle harvested can be used to fill the defect or can be used as chimera to cover the defect. The use of muscle over long standing infective pressure sores can sterilize the wound bed and help in preventing recurrence. The vascularity of this flap is robust and highly reliable. Even after a maximum arc of rotation (up to 170°) all the flaps survived without any major complications.

• Keywords
• pedicled ALT flap – reconstructive surgery – pressure sore – anterolateral thigh flap,
• MeSH
• Humans MeSH
• Myocutaneous Flap * surgery   MeSH
• Retrospective Studies MeSH
• Thigh surgery   MeSH
• Free Tissue Flaps * surgery   MeSH
• Plastic Surgery Procedures * methods   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

INTRODUCTION: The problem of the replacement after manubrial resection can be solved standardly through a pedicled pectoralis major muscle flap (PMMF) defect coverage, harvested thought an accessory incision. We recently established an alternative and easier harvesting technique, also in critical cases (patients with recurrent tumor and after radio-chemotherapy), that improves aesthetic outcome and allows harvesting an adequate muscle flap for an optimal chest wall coverage. MATERIAL AND METHODS: A single center retrospective analysis between 2017 and 2020 was performed. Flap harvest was performed subcutaneously using the same incision resections line, thereby sparing the clavicular and upper sternocostal aspects of the pectoralis muscle. RESULTS: Fifteen patients with recurrent tumors after radio-chemotherapy and involving the upper thoracic inlet underwent manubrial resection with associated extended upper mediastinal dissection and replacement using a pectoralis major island flap following our harvesting technique. The majority (70%) of patients had an uneventful course of recovery and showed satisfying aesthetic results and low donor site morbidity. Four (26%) patients had major complications that required surgical revision. All patients had early postoperative shoulder mobilization without functional deficit or aesthetic deformity. CONCLUSIONS: Pedicled pectoralis major muscle flap (modified harvesting) provides an adequate replacement of the upper thoracic inlet, with excellent aesthetic and functional results, also in high risk patients.

• Keywords
• reconstructive surgery,
• MeSH
• Surgical Wound * surgery   MeSH
• Surgical Flaps MeSH
• Humans MeSH
• Neoplasms * surgery   MeSH
• Pectoralis Muscles transplantation   MeSH
• Retrospective Studies MeSH
• Plastic Surgery Procedures * methods   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

INTRODUCTION: The temporoparietal fascia flaps (TPFF) have been widely used to cover the framework in auricular reconstructions. However, flap harvesting is mostly done by open surgery which may be easier but often results in bad scarring and hair loss. We would like to present a series of cases using endoscopic-assisted flap harvesting techniques with only one single cosmetic auricular incision. PATIENTS AND METHODS: Prospective studies from June 2018 to September 2021 on patients who underwent single-stage total auricular reconstruction using autologous costal cartilage and porous polyethylene (PPE) framework. Variables include age, gender, flap survivability as well as visual results and complications. RESULTS: A total of 61 TPFFs were harvested to cover 15 autologous costal cartilages and 46 PPE frameworks in 60 patients (one patient had operation on both sides). TPFF harvests are performed by endoscopic techniques with one single auricular incision. There was no flap necrosis, no bleeding and no cases required framework removal. Only 7/61 (11.5%) ears had small framework exposure which resolved on their own or only required local skin flap coverage and 1 ear had frontal nerve injury. CONCLUSION: Single-stage auricular reconstruction is a difficult surgery, yet greatly beneficial to young children. Through a single-incision endoscopic technique, we can obtain sufficiently large high-survivability TPFFs ensuring full coverage of the autologous costal cartilage or PPE framework. This method is reliable, and reproducible with advanced training. After reviewing the literature, we can state that our report probably includes the largest endoscopic-assisted TPFF harvesting series and the first to implement single-incision endoscopic technique in auricular reconstructions.

• Keywords
• auricular defect, auricular reconstruction, microtia, porous polyethylene framework, single incision endoscopy, temporoparietal fascia flap,
• MeSH
• Surgical Wound * MeSH
• Surgical Flaps MeSH
• Child MeSH
• Fascia MeSH
• Humans MeSH
• Polyethylene MeSH
• Child, Preschool MeSH
• Prospective Studies MeSH
• Plastic Surgery Procedures * methods   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Child, Preschool MeSH
• Publication type
• Journal Article MeSH
• Names of Substances
• Polyethylene MeSH

The latissimus dorsi (LD) myocutaneous flap is heavily used in reconstructive plastic surgery as either a local or distant flap, and mostly for coverage of large defects. To date, only a limited number of studies have described the use of an LD flap for functional reconstruction. Restoration of the extensor mechanism remains an unexplored area, and several issues remain to be addressed. First, generally accepted recommendations for the surgical technique do not include specific steps to achieve functional qualities of the upper extremity after complete removal of the triceps brachii muscle. Second, to date, it has not been clarified whether elbow extension requires correction because the movement can be naturally compensated for by gravity. To contribute to the current knowledge base in this field, the authors describe a technique for the reconstruction of an extensor mechanism of the elbow by transferring a pedicled functional LD flap while maintaining an intact insertion. Reconstruction was performed in a patient who experienced a second recurrence of a malignant peripheral nerve sheath tumor and underwent complete excision of the triceps brachii muscle. After excision, a meshed epidermal graft was used for wound closure. The patient's postoperative course was uneventful. His elbow was immobilized for 3 weeks using an elbow splint, followed by intensive rehabilitation. The functional result was excellent, with an Enneking limb function score of 26. During the 16-month follow-up, no signs of local recurrence or systemic spread were observed.

• Publication type
• Journal Article MeSH
• Case Reports MeSH

Fournier's gangrene (FG) is a necrotizing fasciitis of the genital, perianal and perineal regions, caused by multiple anaerobic/aerobic infection. It is a rare but very serious condition with multiple long-term complications and high mortality rate. Early diagnosis and multidisciplinary approach in treatment of complicated cases of FG are crucial to the successful outcome. We report a case of an extensive FG in a 59-years-old female patient with multiple risk factors such as obesity, type 2 diabetes and hypertension. She was hospitalized as an emergency case with diabetic ketoacidosis, sepsis and extensive necrotic lesions located perineal, perianal, genital and spread to inguinal, hypogastric, gluteal and sacrococcygeal region. Fournier's gangrene was diagnosed, and after prompt resuscitation, intravenous fluids, broad-spectrum antibiotics, insulin infusion, emergency aggressive surgical debridement was performed. Several aerobic and anaerobic bacteria were isolated from wound culture and hemoculture. Patient has second debridement after four days. After second debridement was applied metabolic control, broad-spectrum antibiotics coverage, dressing the wound and negative pressure wound therapy (NPWT). Patient was discharged home five weeks after a second debridement in good condition. One month later she underwent reconstructive surgical treatment. Besides extensive FG and multiple comorbidity she was successfully managed with good outcome. Fournier's gangrene remains a life-threatening and fulminant disease which need urgent diagnosis and aggressive medical and surgical treatment, to achieve a reduction in long term complications and mortality rate.

• Keywords
• Debridement, Fournier’s gangrene, Negative pressure wound therapy,
• MeSH
• Anti-Bacterial Agents therapeutic use   MeSH
• Debridement MeSH
• Diabetes Mellitus, Type 2 * MeSH
• Fournier Gangrene * drug therapy   therapy   MeSH
• Comorbidity MeSH
• Middle Aged MeSH
• Humans MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH
• Names of Substances
• Anti-Bacterial Agents MeSH