Reconstruction of a Large Composite Hemicraniofacial Defect with Bipedicled DIEP/TRAM Flaps.

Head and neck reconstructions are often challenging due to the mix of functional and aesthetic goals. It can be tricky when different tissue types are required to reconstruct each subunit. Craniofacial reconstructions require a large volume of tissue to cover defects that span across a large convex area. The latissimus dorsi muscle flap is a workhorse free flap used frequently by surgeons due to its ability to cover over a large surface area. However, there are unique situations when even the latissimus dorsi muscle is not enough to provide the bulk cover for the craniofacial defect. We present a complex case of a hemicraniofacial reconstruction after a hemifacial orbital exenteration and cranial resection of a large neglected basal cell carcinoma.

A Novel Technique of Total Scrotal Resurfacing with NovoSorb Biodegradable Temporizing Matrix for Testicular Preservation.

The reconstruction choice of scrotal defects after Fournier gangrene has been routinely based on the reconstructive ladder. Defects are usually managed with either skin-grafting or regional flaps to achieve testicular coverage. However, skin grafting done directly to testes may lead to chronic pain issues, and skin flaps can potentially be too thick to achieve good temperature control for spermatogenesis. We present the first reported case of total scrotal resurfacing after Fournier gangrene in a 48-year-old patient with NovoSorb Biodegradable Temporizing Matrix. The patient showed a good cosmetic outcome with no residual pain issues. Further research is recommended to further investigate the long-term effects of scrotal reconstruction with Biodegradable Temporizing Matrix.

The Tree Flap: A Novel Modification of the Hatchet Flap for Lower One-third Nasal Reconstruction.

Nasal reconstruction after skin cancer excision has routinely been challenging without any aesthetic sequelae, and any defects on the nose are readily noticeable. To circumvent this problem, surgeons have developed different flap techniques to mobilize adjacent tissue to repair aesthetically sensitive defects. We describe our experience, outcomes, and valuable tips for using the "tree flap," a novel modification of the hatchet flap that extends the back cut to significantly increase mobility, leaving only a small skin paddle to maintain perfusion to the flap. The combination of undermining, a rotatory component, and minimal skin attachment allows radical mobility without compromising blood supply. Thus, the tree flap allows for reconstruction of defects of the dorsum of the nose and defects near the nasal tip with ease, given both advancement and rotational movements. Compared with other local flaps such as the shark pedicle flap or bilobed flap, the tree flap has a similar learning curve, minimal donor site morbidity, and equivalent aesthetic outcome. It may be used to repair larger defects that may not be amenable to the bilobed flap as an alternative to a full-thickness skin graft. In our experience, the tree flap also has the advantage of a lower rate of pin cushioning when compared with other options such as the bilobed flap. The tree flap has great mobility and is a reliable option for reconstruction of the lower one-third of the nose with excellent aesthetic results and minimal complications.