Reconstrucción fálica microquirúrgica / Microsurgery for phallic reconstruction

RESUMEN Antecedentes: la falta de pene causa trastornos físicos y psicológicos graves. Su reconstrucción es compleja porque comprende restituir aspectos morfológicos y funcionales. El colgajo radial microquirúrgico (CRM) es una de las mejores opciones para la reconstrucción fálica (RF). Objetivo: describir los resultados de una serie de pacientes con RF mediante CRM. Material y métodos: trabajo observacional descriptivo a través de la revisión de los registros de pacientes a quienes se les realizó RF con CRM entre julio de 2014 y julio de 2017, no relacionados con disforia de género. Resultados: tres pacientes, de 27, 36 y 22 años, fueron reconstruidos, respectivamente, por amputación traumática, secuela de tratamiento oncológico y por malformación congénita. No se presentaron necrosis de los colgajos. La sensibilidad somática fue efectiva en los tres casos y la erógena en uno. Todos los pacientes refirieron satisfacción general con el procedimiento. Conclusión: el CRM, realizado por un equipo multidisciplinario, permitió una RF satisfactoria. La reconstrucción de la uretra debe ser decidida

ABSTRACT Background: The absence of the penis causes serious physical limitations and psychosocial distress. Phallic reconstruction (PR) is a complex procedure because it involves the restoration of morphological and functional aspects. The radial forearm flap (RFF) is one of the best options for PR. Objective: The aim of this study was to describe the results of a series of patients undergoing PR using RFF. Material and methods: We conducted a descriptive observational study by reviewing the records of patients who underwent PR with RFF not related to gender dysphoria between July 2014 and July 2017. Results: Three patients aged 27, 36, and 22 years underwent reconstruction for traumatic amputation, oncologic treatment sequelae, and congenital defect, respectively. None of the patients developed flap necrosis. Somatic sensation was effective in all three cases and erogenous sensation in one. All patients reported overall satisfaction with the procedure. Conclusion: The use of RFF for PR by a multidisciplinary team produced satisfactory and uncomplicated results. Urethral reconstruction should be decided depending on each patient.

Anatomical Review of Fibular Composite Free Flap for Oral and Maxillofacial Reconstruction

Nasal Reconstruction with Chondrocutaneous Preauricular Free Flap and Interpositional Vascular Graft: A Case Report

PURPOSE: Reconstruction of a full thickness defect of the nose is a difficult task for plastic surgeons because the anatomical characteristic, shape, and function of the nose all need to be taken into consideration. Most often, a local flap or a composite graft is used, but for a large defect, reconstruction using free flaps is the most ideal method. In free flap reconstruction, the chondrocutaneous preauricular area can be a suitable donor site. We performed a chondrocutaneous preauricular free flap with an interpositional vascular graft for reconstruction of a nasal ala. METHODS: A 46 year-old male presented to the hospital with a right alar deformity induced by a dog bite. During the surgery, the existing scar tissue was removed and thereby a newly formed full thickness defect was reconstructed using the chondrocutaneous preauricular free flap with an interpositional vascular graft harvested from the descending branch of the lateral femoral circumflex vessel between the facial and superficial temporal vessels of the free flap. RESULTS: The flap survived without flap loss and showed symmetry in its overall shape, contour, texture, and color. The patient was satisfied with the results and the surgery yielded no additional scars at the nasolabial fold area. CONCLUSION: The chondrocutaneous preauricular free flap is a valuable method in reconstruction of full thickness defects of the nose, and using the descending branch of the lateral femoral circumflex vessel as the interpositional vascular graft at the anastomotic site produces reliable results.