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Objective:To evaluate clinical efficacy of bipedicled scrotal flaps combined with keystone-design perforator island flaps in repairing postoperative large-area defects in male patients with extramammary Paget′s disease of the perineum.Methods:Clinical data were collected from 6 male patients with extramammary Paget′s disease of the perineum in Dermatology Hospital of Jiangxi Province from February 2018 to March 2019, and analyzed retrospectively. These patients were aged from 70 to 84 years (median, 77.5 years) , skin lesions involved the mons pubis, penis and scrotum, and the area of postoperative skin defects varied from 18 to 133 cm 2 (median, 96 cm 2) in size. In all the patients, mons pubis defects after tumor resection were repaired with abdominal keystone-design perforator island flaps, and scrotal and penile defects were repaired with bipedicled scrotal flaps using the remaining scrotal tissues. These patients were followed up at 1 and 3 months after surgery and every 3 months thereafter. Results:All the 6 patients were followed up for 3 - 36 months, with an average of 10 months. All flaps survived with a good color and texture match, and favorable function and appearance were achieved in both the donor and recipient sites.Conclusions:The bipedicled scrotal flaps combined with keystone-design perforator island flaps can repair postoperative large-area defects in male patients with extramammary Paget′s disease of the perineum. Moreover, the operation is simple, and good blood supply can be achieved.
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Introduction: In Homo sapiens and other mammalianquadrupeds, there is an absence of posterior rectus sheathbelow the arcuate line and insubstantial transversalis fasciain groin. This anatomical arrangement presents no particularfunctional, anatomic difficulty for quadrupeds as their inguinalcanal is directed uphill during ambulation and therefore isnot subjected to significant gravitational stress. Aims andobjectives: To evaluate the efficacy of bipedicled strip ofexternal oblique aponeurosis for augmentation of posteriorwall of inguinal canal in inguinal hernia repair.Material and methods: This study was carried out onfifty consecutive patients of inguinal hernia admitted in theSurgery Department of Guru Nanak Dev Hospital attached toGovernment Medical College, Amritsar.Conclusion: The present study was an attempt to evaluatethe role of bipedicled strip of external oblique aponeurosis inaugmentation of posterior wall of inguinal canal in inguinalhernia repair. Our findings suggest that the bipedicledundetached strip of external oblique aponeurosis is as efficientas a synthetic mesh in inguinal hernia repair. This repair isalso economically more beneficial for poor patients whocannot afford to have mesh repair. Although the present studyis small and follow up period is short but we still recommendthis procedure as a good alternative to Modified Bassini’s,Shouldice repair and mesh based repairs
RESUMEN
In Homo sapiens and other mammalian quadrupeds, there is an absence of posterior rectus sheath below the arcuate line and insubstantial transversalis fascia in groin. This anatomical arrangement presents no particular functional, anatomic difficulty for quadrupeds as their inguinal canal is directed uphill during ambulation and therefore is not subjected to significant gravitational stress. Aims and objectives: To evaluate the efficacy of bipedicled strip of external oblique aponeurosis for augmentation of posterior wall of inguinal canal in inguinal hernia repair. Material and methods: This study was carried out on fifty consecutive patients of inguinal hernia admitted in the Surgery Department of Guru Nanak Dev Hospital attached to Government Medical College, Amritsar. Conclusion :The present study was an attempt to evaluate the role of bipedicled strip of external oblique aponeurosis in augmentation of posterior wall of inguinal canal in inguinal hernia repair. Our findings suggest that the bipedicled undetached strip of external oblique aponeurosis is as efficient as a synthetic mesh in inguinal hernia repair. This repair is also economically more beneficial for poor patients who cannot afford to have mesh repair. Although the present study is small and follow up period is short but we still recommend this procedure as a good alternative to Modified Bassini's, Shouldice repair and mesh based repairs.
RESUMEN
Breast reconstruction using TRAM flap after mastectomy has been widely adopted and regarded as a gold standard method. In patients with the abdominal midline scar, insufficient blood circulation to regions contralateral to the pedicle disables inclusion of them in the TRAM flap design. So modifications including Double- pedicled TRAM, Super-charged, Turbo-charged, Bipedicled free TRAM et al. have been attempted to resolve the problem of circulatory interruption by midline scar. The authors designed a new bipedicled free TRAM flap to avoid limitations like epigastric buldging, significant abdominal weakness and complexity of flap insetting. The two donor arteries(right and left deep inferior epigastric arteries) are anastomosed to the proximal and distal ends of divided internal mammary arteries using the reverse flow. Vein anastomoses were performed in the same manner through the divided venae comitantes. Two patients having infraumbilical midline scar underwent breast reconstruction using author`s new flap. Flaps survived without fat necrosis or partial flap loss in both patients and their results in aesthetic aspects were very satisfactory. Compared to previous method for breast reconstruction of patients having infraumbilical midline scar, author's new method is useful and effective in terms of the aesthetic and technical aspect.