ABSTRACT
Objective: To evaluate the effectiveness of pedicled skin flap of foreskin for phalloplasty and Sugita surgical method in the treatment of complete concealed penis. Methods: The clinical data of 46 children with complete concealed penis between January 2016 and January 2018 were analyzed retrospectively. Among which, 25 cases were treated with pedicled skin flap of foreskin for phalloplasty (group A) and 21 cases were treated with Sugita surgical method (group B) with an average age of 4.7 years (range, 2 years and 8 months to 11 years). At 3 months after operation, the concealed penis recovery was scored from three aspects of postoperative penis length (the difference of the penis length between at 3 months after operation and before operation), penis appearance, and skin appearance (the total score was 10). And the parents evaluation of satisfaction degree of penis exposure, penis appearance, and foreskin appearance after surgical correction was collected. Results: Eighteen cases (72.0%) in group A and 15 cases (71.4%) in group B were followed up with an average of 13 months (range, 3-36 months). The incisions healed well in both groups, and there was no flap dehiscence, infection, necrosis, and penile erectile dysfunction. The penile length of the two groups increased significantly at 3 months after operation ( P0.05). No penile retraction occurred in the two groups. And there was no significant difference between the two groups in penis appearance score, but the penis appearance score, skin appearance score, and total score of group A were significantly better than those of group B ( P<0.05). At 3 months after operation, the satisfaction rate of penis exposure in group A and group B was 88.9% and 80.0%, respectively, with no significant difference ( χ2=0.50, P=0.48); the satisfaction rate of penis appearance was 72.2% and 53.3%, and the satisfaction rate of foreskin appearance was 94.4% and 53.3%, respectively, and the differences were significant ( χ2=5.13, P=0.03; χ2=7.53, P=0.01). Conclusion: Both surgical methods are suitable for correction of complete concealed penis, and the penile length gets a satisfactory recovery. However, the lymphedema of the prepuce after Sugita surgical method is serious, which can easily lead to poor appearance of the penis after operation. In general, the effectiveness of pedicled skin flap of foreskin for phalloplasty is better than that of the Sugita surgical method.
ABSTRACT
Objective@#To analyze the causes of local necrosis and hemodynamics after pedicle peroneal perforator flap and try to find out prevention strategies.@*Methods@#Retrospective 17 tissue defect cases admitted by Plastic and Reconstructive Surgery of Ningbo First Hospital, which treated by pedicle perforator flap with kinds of complications. 3 of 17 were naked the perforators to reduce reverse pressure. Patients involved 12 male, 5 female, ages from 22 to 46, with defected area from 5.0 cm×11.0 cm to 8.0 cm×14.0 cm, located in lateral ankle.@*Results@#3 to 5 days postoperative 12 cases with distal local necrosis, all of which were designed interregional, one with performator naked, turned back after drainage and wound dressing, 3 cases were gradually swelling and purple postoperative, two of them were perforator naked. 1 weeks later, the distal skin of flap necrosis and were gradually turning black scab appeared.With scab cutting and fascia survived, no bony tissues exposure, after 0.5% povidone iodine wet dressing regularly, endothelial cells crawled to cover. 2 cases with larger ranger of swelling and purple, not be better even pedicale releasing was conducted, 2 weeks later most part of the flap necrosis and the distal turned black eschar. After debridement and skin grafting, wounds healed later.All patients were followed up for 3 months with no flap transplantation required.@*Conclusions@#Coaxial homology, within 2 choke vessel areas, perforator skeletonization, kick out the small saphenous vein, might be the ways to reduce the complication of the cross area designing trans pedicled peroneal perforator flap.
ABSTRACT
Objective@#To explore the feasibility and technical points of soft tissue defect reconstruction using the pedicled anterolateral thigh flap based on perforating vessels from the lateral circumflex femoral artery oblique branch.@*Methods@#Between November 2009 and April 2019, 27 pedicled anterolateral thigh flaps were performed to repair the wound of trunk and lower extremity, based on perforating vessels from the lateral circumflex femoral artery oblique branch. 16 flaps were proximally based and 11 were distally based.@*Results@#The proximally based flap ranged from 15 cm×8 cm to 32 cm×12 cm. The mean length of the pedicle was 8.2 cm. The distally based flap ranged from 9 cm×7 cm to 24 cm×8 cm. The mean length of the pedicle was 18.6 cm. All flaps survived after surgery. Venous congestion occurred in one flap and relieved in five days.@*Conclusions@#With oblique branch as the pedicle, the vascular dissection was easy and donor site morbidity was minimized while harvesting the proximally based anterolateral thigh flaps; long pedicle could be obtained, and the reconstructive sphere was extended when using the distally based anterolateral thigh flaps.
ABSTRACT
Objective@#To investigate the anterior branch of subcostal artery perforator flap for defects at the lower abdomen or distal sites.@*Methods@#Ten patients were treated, including 6 males and 4 females, aged 25 to 62 years, mean (38.2 ± 6.5) years old. The anterior branch of subcostal artery perforator flap was designed in 10 cases, of which 1 case was free flap carrying the accompanying nerve. 9 cases had defects at abdomen and 1 case at the foot. The flaps size was 4 cm×8 cm-7 cm ×15 cm.@*Results@#All the 10 flaps survived completely with no vascular crisis. The abdominal shape was good with only linear scar. The free flap was used for plantar wound with nerve anastomosis of accompanying nerve with the medial plantar nerve. During the follow-up period of 6 months, the flap sensory recovery area reached more than 60% with two-point discrimination as 20-25 mm.@*Conclusions@#The anterior branch of subcostal artery perforator flap has a stable vascular pedicle with reliable vascular network and sensory nerve.
ABSTRACT
Objective To explore the effect of great saphenous vein interruption on distally saphenous neurocutaneous pedicled skin flap. Methods Fifty-two patients with skin and soft tissue lost on ankle received neoplasty using distally crural saphenous neurocutaneous pedicled skin flap. The patients were divided into two groups: the patients in interruption group (25 patients) were treated with great saphenous vein interruption on distally saphenous neurocutaneous pedicled skin flap, the patients in conventional group (27 cases) were treated without saphenous vein interruption. Results Primary healing: 15 patients (55.56%, 15/27) in conventional group, 21 patients (84.00%,21/25) in interruption group. With effusion: 17 patients (62.96%,17/27) in conventional group, 7 patients(28.00%,7/25) in interruption group. With venous crisis: 10 patients (37.04%,10/27) in conventional group, 2 patients (8.00%,2/25) in interruption group. There was statistical significance between two groups on the above 3 indexes (P 0.05). Conclusions Great saphenous vein interruption could relieve swelling, reduce effusion and have higher primary healing rate in neoplasty using distally crural saphenous neurocutaneous pedicled skin flap compared with the conventional method, which greatly reduce the pain and medical expenses of the patients.
ABSTRACT
Severe injuries of hands frequently expose the bone and joint due to the defect of crushing of soft tissues. Although the several methods are introduced, the treatment of bone and joint exposure of finger and hand is very difficult to control satisfactorily. From October 1986 to February 1988, we performed the pedicled skin flap in 11 cases; 9 abdominal skin flaps and 2 pectoral skin flaps. Follow up stuides showed good results. The successful surviving of flaps was accomplished in all cases and the dead bones were regenerated by the creeping substitution. Therefore this pedicled skin flap operation can be considered to be a simple and effective method in treating the bone and joint exposure of fingers.