A Bibliometric and Visualisation Analysis on the Research of Female Genital Plastic Surgery Based on the Web of Science Core Collection Database.

BACKGROUND AND OBJECTIVES: Due to the increasing demand for improving the morphology and function of the external genitalia amongst women, it is necessary to conduct statistical analysis of research data on female genital reconstruction. The current study aimed to use bibliometric analysis to analyse the research hotspots and trend frontiers of the female genital reconstructive research. METHODS: Publications on the female genital reconstructive research were extracted from the Web of Science Core Collection database. VOSviewer 1.6.18 was used to establish visualisation maps and find top authors, institutions, countries, burst keywords, co-cited authors, journals, research hotspots, and trends. RESULTS: A total of 2207 studies published by 364 different journals authored by 7479 researchers were contained in this study. In the co-authorship analysis, the bulk of the retrieved studies was conducted by the USA, followed by England, Italy, and Netherlands, whilst the most productive institution, journal, and author were U.S. Univ Calif San Francisco, Journal of Sexual Medicine, and Bouman Mark-Bram, respectively. In the co-cited analysis, the top most-cited author and journal were Hage JJ and Journal of Sexual Medicine, respectively. The map of keywords occurrence revealed the most active research aspects were focussed on "vaginoplasty", "feminised genitoplasty", "laser treatment of vaginal atrophy", "transsexualism", and "labiaplasty". The time overlay mapping showed that the study of female genital plastic surgery focusses on the energetic treatment of genitourinary syndromes caused by transsexualism and menopause, especially by using management and treatment of vulvovaginal atrophy for the research trends, and through the vaginoplasty, feminising genioplasty, and laser treatments in the direction of treatments related to physical and mental problems. INTERPRETATION AND CONCLUSIONS: This novel inclusive bibliometric analysis can help research workers to quickly understand the potential and active researchers, landmark studies, and topics within their interests. We are willing to provide more beneficial data to contribute valuable research of female genital plastic surgery through this study. LEVEL OF EVIDENCE III: The journal asks authors to assign a level of evidence to each article. For a complete description of Evidence-Based Medicine ratings, see the Table of Contents or the online Instructions for Authors at www.springer.com/00266 .

Umbilical cord-derived mesenchymal stem cell secretome promotes skin regeneration and rejuvenation: From mechanism to therapeutics.

How to effectively repair cutaneous wounds and promote skin rejuvenation has always been a challenging issue for clinical medicine and medical aesthetics. Current conventional medicines exhibit several drawbacks, including limited therapeutic effects, prolonged treatment periods, and high costs. As a novel cell-free therapy, the umbilical cord-derived mesenchymal stem cell (UCMSC) secretome may offer a promising approach for skin regeneration and rejuvenation. The UCMSC secretome is a collection of all proteins secreted by mesenchymal stem cells, including conditioned media, exosomes, and other substances. The UCMSC secretome has numerous abilities to accelerate acute wound healing, including high fibroblast and keratinocyte proliferative activity, pro-angiogenesis, anti-inflammation, anti-fibrosis, and anti-oxidative stress. Its impact on the four stages of wound healing is manifested by inducing the haemostasis phase, inhibiting the inflammation phase, promoting the proliferation phase, and regulating the remodelling phase. Furthermore, it is highly effective in the treatment of chronic wounds, alopecia, aging, and skin homeostasis disturbance. This review focuses on the clinical therapies and application prospects of the UCMSC secretome, encompassing its source, culture, separation, identification, storage, and pretreatment. Additionally, a discussion on the dosage, administration route, efficacy, and biosafety in the clinical situation is presented. This review aims to provide scientific support for the mechanistic investigation and clinical utilisation of the UCMSC secretome in wound healing and skin rejuvenation.

MSC-Exos: Important active factor of bone regeneration.

Bone defect and repair is a common but difficult problem in restorative and reconstructive surgery. Bone tissue defects of different sizes caused by different reasons bring functional limitations and cosmetic deformities to patients. Mesenchymal stem cells (MSC), a major hotspot in the field of regeneration in recent years, have been widely used in various studies on bone tissue regeneration. Numerous studies have shown that the bone regenerative effects of MSC can be achieved through exosome-delivered messages. Although its osteogenic mechanism is still unclear, it is clear that MSC-Exos can directly or indirectly support the action of bone regeneration. It can act directly on various cells associated with osteogenesis, or by carrying substances that affect cellular activators or the local internal environment in target cells, or it can achieve activation of the osteogenic framework by binding to materials. Therefore, this review aims to summarize the types and content of effective contents of MSC-Exos in bone regeneration, as well as recent advances in the currently commonly used methods to enable the binding of MSC-Exos to the framework and to conclude that MSC-Exos is effective in promoting osteogenesis.

Research Hotspots and Emerging Trends of Facial Rejuvenation: A Bibliometric Analysis.

BACKGROUND: In recent years, the demand for facial rejuvenation is increasing year by year. This study aims to use bibliometric analysis to construct a visualization map of the facial rejuvenation research and provide the research hotspots and trend frontiers in the field. METHODS: Publications on facial rejuvenation research were extracted from the Web of Science Core Collection database. VOSviewer 1.6.18 was used to analyze the co-authorship, the citations of countries, institutions, and authors, the co-occurrence of keywords, and the journals in which the studies were published. RESULTS: In total, 6,196 records of facial rejuvenation research published between 2000 and 2021 were collected. The USA had published the most publications in this field (2,647), and its main partners were Canada, Germany, and China. University of California, Los Angeles, was the institution with the greatest contribution (127 publications). Plastic and Reconstructive Surgery (623 publications) published the most research in this field and was also the most frequently co-cited journal (17,349 citations, total link strength: 586,955). Rohrich RJ (70 publications) was the most prolific and most frequently co-cited author (1,230 citations, TLS: 26,603). Among the 100 most cited articles, 57 articles are amenable to grading level of evidence, and most papers presented their findings utilizing level IV evidence. CONCLUSIONS: At present, the research hotspots in this field included the following six aspects: facial photoelectric therapy, aging manifestation and treatment in the middle of the face, the application of autologous fat transfer in facial rejuvenation, facial plastic surgery, facial injection cosmetology, and rhytidectomy and related anatomy. According to the analysis of the timing diagram, the research trends were esthetic medicine, mesenchymal stem cells, laser therapy, the application of platelet-rich plasma, and platelet-rich fibrin. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A Bibliometric and Visualization Analysis on the Research of Fat Grafting from 1945 to 2021.

BACKGROUND: It is very important to generate a comprehensive assessment of the fat grafting field due to the rapid growth of scientific literature. The current study aimed to use bibliometric analysis to evaluate fat grafting research qualitatively and quantitatively and determine the research hotspots and trends in this field. METHODS: Publications on fat grafting research were extracted from the Web of Science core collection database. VOSviewer 1.6.18 was applied to perform the bibliometric analysis of these articles. RESULTS: A total of 2558 studies published by 594 different journals authored by 9097 researchers were contained in this study. In the co-authorship analysis, the bulk of the retrieved studies was conducted by the USA, followed by China, Italy and Japan, while the most productive institution, journal and author were Chinese Academy of Medicine Sciences, Plastic and Reconstruction Surgery and Klinger M, respectively. In the co-cited analysis, the most top cited author, journal, organization and country were Coleman Sr, Plastic and Reconstruction Surgery, New York University and the USA, respectively. The map of keywords occurrence revealed the most active research aspects were focused on "surgery," "cell," "breast reconstruction" and "survival" and the time overlay mapping showed that the most active research hotspots were "breast reconstruction" and "retention". CONCLUSIONS: The research hotspots include the following four aspects: aesthetic surgeries, cell-assisted lipotransfer, breast reconstruction and grafted fat survival. Breast fat grafting and volume retention may be trends in the future. We are willing to provide more beneficial data to contribute valuable research for the fat grafting through this study. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Trends in Breast Augmentation Research: A Bibliometric Analysis.

BACKGROUND: Breast augmentation is one of the most demanded procedures in plastic surgery and one of the most commonly performed by plastic surgeons. However, a bibliometric analysis of breast augmentation has not been published in recent years. The current study aimed to use a bibliometric analysis to conduct a qualitative and quantitative evaluation of breast augmentation research and provide the research trends and hotspots in this field. METHODS: Publications on breast augmentation research were extracted from the Web of Science core collection database. VOSviewer 1.6.18 was used to assess co-authorship, co-occurrence, citation of countries, institutions, authors, and journals, as well as hotspot keywords. RESULTS: On February 8, 2022, 4637 records of breast augmentation research published from 1985 to 2021 were collected. The bulk of the retrieved studies were original research articles (n = 2235, 48.20%). A total of 1053 (22.71%) papers were open access. The annual publication output increased annually. The USA was the driving force in this field and had a strong academic reputation. The top-contributing institution was the University of Texas MD Anderson Cancer Center (2.37%, with 110 publications). Plastic and reconstructive surgery (998 publications, 21.52%) published the most research in this field and was also the most frequently co-cited journal (22,351 citations, total link strength (TLS): 409,301). Clemens MW (68 publications, 1.47%) was the most prolific author, and Spear SL (1456 citations, TLS: 27,231) was the most frequently co-cited author. The research hotspots included the following four aspects: safety and effectiveness of breast implants, implant-based breast reconstruction, breast cancer incidence after breast implantation, and breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL). The research trends were BIA-ALCL, implant-based breast reconstruction, BREAST-Q, acellular dermal matrix, capsular contracture, and autologous fat grafting. CONCLUSION: The present study provides a panoramic view of breast augmentation research in plastic and reconstructive surgery. This novel comprehensive bibliometric analysis can help researchers and nonresearchers alike to rapidly identify the potential partners, research hotspots, and research trends within their areas of interest. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Update on Rhinoplasty Research Trends: A Bibliometric Analysis.

BACKGROUND: Rhinoplasty is one of the most commonly performed aesthetic surgical procedures. The current study aimed to use bibliometric analysis to qualitatively and quantitatively evaluate rhinoplasty research and determine the research trends and hotspots in this field. METHODS: Publications on rhinoplasty research were extracted from the web of science core collection database. VOSviewer1.6.18 was used to analyze the co-authorship, co-occurrence, the citations of countries, institutions, authors, and hotspot keywords, and the journals in which the studies were published. RESULTS: On April 8, 2022, 11,130 records of rhinoplasty research published between 1945 and 2021 were collected. Most of the retrieved studies were original research articles (n = 8309, 74.65%), and 1950 (17.52%) papers were available in an open-access format. The annual publication output increased annually. Research groups in the USA were the main contributors and had a strong academic reputation in this field. University of California System was the institution with the greatest contribution (4.17%, with 464 publications). Plastic and Reconstructive Surgery (1248 publications, 11.21%) published the most research in this field and was also the most frequently co-cited journal (33,894 citations, total link strength [TLS]: 722,672). R. J. Rohrich (140 publications) was the most prolific author and the most frequently co-cited author (2562 citations, TLS: 56,624). The following rhinoplasty research hotspots were identified: cleft rhinoplasty, nasal reconstruction, nasal tip, revision rhinoplasty, septorhinoplasty, nasal prosthesis, hyaluronic acid, and preservation rhinoplasty. CONCLUSION: Our results provide a general overview of the major directions in rhinoplasty research. Preservation rhinoplasty, rib graft, nonsurgical rhinoplasty, hyaluronic acid, FACE-Q, fillers, and three-dimensional technology may be future research hotspots. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Therapeutic Strategies by Regulating Interleukin Family to Suppress Inflammation in Hypertrophic Scar and Keloid.

Hypertrophic scar (HS) and keloid are fibroproliferative disorders (FPDs) of the skin due to aberrant wound healing, which cause disfigured appearance, discomfort, dysfunction, psychological stress, and patient frustration. The unclear pathogenesis behind HS and keloid is partially responsible for the clinical treatment stagnancy. However, there are now increasing evidences suggesting that inflammation is the initiator of HS and keloid formation. Interleukins are known to participate in inflammatory and immune responses, and play a critical role in wound healing and scar formation. In this review, we summarize the function of related interleukins, and focus on their potentials as the therapeutic target for the treatment of HS and keloid.

Unlocking the potential of minimally processed corn germ oil and high oleic soybean oil to prepare oleogels for bakery application.

In this study, the influence of sunflower wax (SFX) concentration (1, 3, 5, 7, and 9 wt%) on the properties of oleogels prepared using expeller-pressed corn germ oil (EPC) or high oleic soybean oil (EPS) was comprehensively investigated. Overall, oleogels can be prepared from both EP oils at an SFX level ≥3 wt%. The strength of oleogels depends on SFX concentration. EPS oleogels had better rheological properties and a higher amount of platelet-like crystals than EPC oleogels. The characteristics of cookies prepared with both oleogels were evaluated and compared to cookies prepared with commercial shortening. The lipid distribution in the cookies as visualized by CLSM suggested that EPS oleogels with a 5 or 7 wt% SFX had a greater possibility of replacing commercial shortening as they exhibited even lipid distribution which enabled good air-incorporation and air retention abilities. This research provides a foundation for developing healthy bakery products by using minimally processed oil based oleogels.

Physical properties and cookie-making performance of oleogels prepared with crude and refined soybean oil: a comparative study.

The objective of this research was to fabricate crude soybean oil oleogels (CSO) using ß-sitosterol (BS) and/or monoacylglycerol (MAG) and compare their role with that of refined soybean oil oleogels (RSO) in cookie making. Both crude and refined soybean oil oleogels were formed with BS or MAG, or the combination of both (1 : 1) at a fixed concentration of 10 wt%. The thermal behavior of the oleogels was measured using differential scanning calorimetry (DSC). The crystal structure and morphology of the oleogels were characterized using X-ray diffraction (XRD) and polarized light microscopy (PLM). The hardness of the oleogel and commercial vegetable shortening was compared using a texture analyzer. The characteristics of cookies made with the oleogels were compared with those of cookies made with commercial vegetable shortening. Overall, the incorporation of BS and/or MAG into crude and refined soybean oil can produce oleogels with solid-like properties. Refined soybean oil formed stronger and firmer oleogels as compared to crude soybean oil. RSO structured by BS presented branched fiber-like, elongated plate-like, and needle-like crystals while the same oil gelled by MAG contained spherulite crystals. RSO made with the combination of BS and MAG displayed crystal morphologies from both BS and MAG. The same crystal morphologies were observed in CSO with lower quantities. Comparing the quality of cookies made with the oleogels and commercial vegetable shortening, equal or better performance of both RSO and CSO in terms of weight, thickness, width, spread ratio, and hardness of cookies than that of commercial vegetable shortening was observed. By combining the results of the physical characterization and cookie making performance, it can be concluded that both crude and refined soybean oleogels could resemble commercial shortening, which offers the possibility of using oleogels to replace shortening in the baking industry.

Nrf2 in keratinocytes protects against skin fibrosis via regulating epidermal lesion and inflammatory response.

Nuclear factor-E2-related factor 2 (Nrf2) is a master transcription factor in antioxidant response, protecting against oxidative damage and various diseases. Previous studies suggest that Nrf2 is suppressed in fibrotic skin and Nrf2 agonists represent a therapeutic strategy, which is mainly attributed to Nrf2 function in fibroblasts. However, constitutive activation of Nrf2 may endow cells with proliferation and survival advantage, facilitating skin tumorigenesis. Non-invasive and mild modulation of Nrf2 via topical application may be helpful. Keratinocytes, which are essential for epidermal formation and function maintenance, have been shown to modulate differentiation of fibroblasts in different stages of fibrosis. In this respect, the role of Nrf2 in keratinocytes in skin fibrosis remains elusive. In the present study, bleomycin (BLM)-induced skin fibrosis model was applied to keratinocyte-specific Nrf2 knockout (Nrf2(K)-KO) mice generated with Keratin 14-Cre/loxp system. BLM treatment significantly suppressed Nrf2 expression in the epidermis. Nrf2 deficiency in keratinocytes exacerbated BLM-induced skin fibrosis according to dermal thickness, and immunostaining of collagen and α-SMA. One-dose BLM treatment led to the emergence of apoptotic cells in the epidermis and an elevated number of macrophages and neutrophils in the dermis, which was aggravated by Nrf2 deficiency, as indicated by TUNEL staining, and expression of F4/80 and Ly6G. In line with in vivo evidence, NRF2 silencing in HaCaT cells significantly decreased cell survival rate in response to BLM due to suppressed expression of antioxidative genes and increased intracellular levels of reactive oxygen species (ROS). The mRNA levels of chemokines and cytokines that are capable of recruiting macrophages and neutrophils, including Mcp-1, Il-6 and Il-8, were increased by Nrf2 deficiency in primary mouse keratinocytes. Moreover, bardoxolone methyl (CDDO-Me), a potent Nrf2 activator, ameliorated BLM-induced skin fibrosis after topical administration. These findings indicate that Nrf2 in keratinocytes protects against skin fibrosis via regulating cell resistance to apoptosis and expression of cytokines and chemokines. The restoration of Nrf2 through topical application might be a potential pharmacologic approach to combat skin fibrosis.

Formation, characterization, and potential food application of rice bran wax oleogels: Expeller-pressed corn germ oil versus refined corn oil.

The expeller-pressed (EP) corn germ oil oleogels were prepared using rice bran wax (RBX) at different concentrations (3, 5, 7, and 9 wt%). Their structural properties, including color, hardness, thermal behavior, rheological property, and crystal structure were evaluated. The performance of oleogels for potential food application was examined by incorporating oleogels into cookies as a fully replacement for commercial shortenings. Overall, RBX could form oleogels in both refined and EP corn germ oils at a concentration ≥3 wt%. Refined corn oil produced a stronger gel than crude corn oil. When comparing cookie characteristics, cookies made with both types of oleogels showed similar properties with commercial cookies. This result indicates that oleogels made by refined and EP corn germ oil together with RBX have the potential to imitate the functionality of commercial shortening in the baking industry.

Resurfacing of the Mid and Lower Faces by Preexpanded Supraclavicular Flap.

Extensive scarring and giant nevi on the mid and lower faces places further demands on scar resurfacing in terms of match, size, and thickness. The area of supraclavicular cervical flap is rather limited, but the expansion could expand its utility in facial resurfacing.Rectangular expanders were inserted via the incisions at the upper fringes of clavicles, and implanted under supraclavicular flap areas. After full expansion, the flap based on supraclavicular artery was elevated to cover the defects left by surgical removal of scar or tumor. Pedicle division was performed on the 10 to 14 days postoperatively.A total of 17 patients were treated with the described technique between 2005 and 2015. The dimensions of the flap ranged from 17 cm × 8.5 cm to 22 cm × 12 cm. The average size was 197 cm. Twenty-one flaps (with 4 patients in bilateral fashion) survived completely. Epidermolysis occurred to 2 flaps, which healed by conservative management. These flaps matched well with the face in terms of the color, thickness, and texture. No obvious flap shrinkage occurred in the follow-up. The donor sites were closed primarily without loss of function or breast deformity.It is an efficient and safe method to obtain preexpanded supraclavicular flap, applying to patients with extensive scarring on mid and lower faces, especially female ones. Excellent aesthetics can be achieved without compromising function and aesthetics of donor sites.

Risk Factors for Urethrocutaneous Fistula Repair After Hypospadias Surgery: A Retrospective Study.

OBJECTIVES: We review our experience in urethrocutaneous fistula (UCF) repair after hypospadias surgery to investigate the risk factors for unsuccessful outcome. METHODS: Two hundred eleven patients had undergone UCF repair in our department from January 2005 to December 2015. This study included 185 patients who were followed up for more than 6 months. The age of patients, size, site and number of UCFs, number of UCF repairs, urethral complications other than UCF, and postoperative infection were included as potential risk factors. Binary logistic regression analysis was used for multivariate analysis. Odds ratio (OR) and 95% confidence intervals (CIs) were calculated. Stratified analysis and assessment of additive interaction were performed to have a better understanding of the relation between the risk factors. RESULTS: Urethrocutaneous fistula repairs failed in 38 patients (20.5%) at first attempt. In the univariate analysis, size of UCFs (P = 0.012), times of UCF repair (P = 0.008), and postoperative infection (P = 0.044) were statistically related with the outcome of surgery. In the multivariate analysis, only the size of UCFs (P = 0.030; adjusted OR, 2.42; 95% CI, 1.09-5.36) and times of repair (P = 0.008; adjusted OR, 3.09; 95% CI, 1.35-7.07) were identified as risk factors for unsuccessful outcome. We had consistent results in the stratified analysis. No additive or multiplicative interaction between the 2 risk factors was found. CONCLUSIONS: Our study suggested that UCF repairs after hypospadias surgery were easier to fail if one of the UCFs was larger than 2 mm or it had been repaired repeatedly. But when both factors existed, the increase of the risk was not statistically significant. The age of patients, site and number of UCFs, complications other than UCF, and postoperative infection were not significantly related to the success rate of UCF repair.

Long-Term Follow-Up of Flap Prefabrication in Facial Reconstruction.

BACKGROUND: Flap prefabrication is to turn a random flap into an axial flap by transferring a vascular pedicle. METHODS: In the past 13 years, we have prefabricated 20 flaps in 20 patients by the superficial temporal artery and its concomitant veins. Typically, a 50- to 800-mL tissue expander was implanted in the donor site. After flap maturation, the prefabricated flap was raised and transferred locally to cover the large defect on the face. All the cases were followed up regularly. RESULTS: The patients' age were between 3 and 27 years, the size of the flaps were between 3.5 × 5.5 cm and 13 × 15 cm, the superficial temporal artery length was between 10 and 15 cm. All flaps were transferred successfully: 10 of the flaps had venous congestion, partial epidermis exfoliation and flap necrosis occurred in 4 flaps. All cases were followed up for at least 1 year, the longest follow-up period was 9 years. Long-term follow-up results showed the prefabricated flap survived in good condition and had a satisfactory outcome. CONCLUSIONS: Because flap prefabrication is practical, and long-term follow-ups have proved its preferable characters and stability, it is a fine method for large area facial reconstructions.

[One-stage reconstruction of distal urethra with free graft of tublar oral mucosa ].

Objective To investigate the therapeuctic effect of one-stage reconstruction of distal urethra with free graft of tublar oral mucosa. . Methods: Two strips of oral mucosa graft(0.4-0.6 cm in width),were harvested and sutured around an oiled silk roll to form mucosa tube. The mucosa tube was used to reconstruct distal urethra. Postoperative pressure dressing and earlier urination were recommended Results: From May 2007 to October 2015,16 cases with distal urethra defect or stenosis were treated with this method. The urethra defect was 2-4 cm in length. Urethral fistula happened in 3 patients. All the other 13 cases healed primarily.10 cases were followed up for 1-5 years by telephone with normal function. Conclusions: One-stage reconstruction with free graft of bulbar oral mucosa is suitable and reliable for distal urethra defect less than 4 cm in length.

[Application of V shape flap for the urethral external meatus and glanuloplasty].

OBJECTIVE: To discuss the methods for urethral external meatus and glanuloplasty after correction of hypospadias. METHODS: The V shape flap on the dorsal side of glan, combined with the bilateral glan flaps were moved to the ventral side. The flap at the ventral side of urethral external meatus was turned over. Then the urethral external meatus was repositioned to the top end of glan with the ventral defects covered by the dorsal flaps. Then the coniform glan was reconstructed. RESULTS: From January 2008 to December 2013, 28 cases were treated, including glandular hypospadias, postoperative retraction of external urethral meatus and meatal stenosis. 21 patients were followed up for 1 -12 months (average, 1 month) with marked improvement of glan appearance and retraction of external meatus. No meatal stenosis happened. CONCLUSIONS: Postoperative retraction of urethral external meatus and meatal stenosis can be corrected by V shape flap on the dorsal side of glan combined with the bilateral glan flaps. The flat appearance of glan can be improved. It is an ideal method for glandular hypospadias.

Augmentation Phalloplasty With Autologous Dermal Fat Graft in the Treatment of "Small Penis".

BACKGROUND: Our objective is to report on the efficacy and safety of dermal fat graft in augmentation phalloplasty performed on patients who presented complaining of "small penis," and evaluate the cosmetic and psychological outcomes of it. METHODS: From April 2010 and January 2015, 23 Chinese adult patients aged 18 to 33 years (average, 23 years) with subjective perception of small penis were included; all who requested an increase in the penile dimension underwent penile elongation (suprapubic skin advancement-ligamentolysis) and girth enhancement by dermal fat graft. Besides objective measurement, Male Genital Image Scale was used to facilitate selection of patients and evaluate the outcome, respectively. The change and shrinkage of the dermal fat strips was evaluated by ultrasound examination and computed tomography. RESULTS: No major complications or erection deficiencies occurred during the postoperative follow-up period. After 6 months, the mean flaccid length was increased by 2.27 ± 0.54 cm, whereas the mean flaccid circumference gain was 1.67 ± 0.46 cm. Significant improvement of genital satisfaction was reported during the follow-up. The shrinkage of dermal fat strips was inconspicuous, and no curvature was observed due to fibrosis. CONCLUSIONS: With strict patient selection, this procedure is proved to be a plausible and reasonable option for patients with penile dysmorphophobia. Also, it provides a potential alternative procedure to current dominant methods and promotes the aesthetic results with penile lengthening.

Modified Penile Augmentation by Dermal-Fat Graft in Post-Hypospadias Adults.

BACKGROUND: Although a considerable part of patients desire further improvement in penile size after hypospadias repairs, penile augmentation is only considered in patients with congenital penile hypoplasia or acquired penile retraction. Modified penile augmentation by free dermal-fat graft is introduced to satisfy these patients and improve surgical safety. METHODS: From April 2012 to December 2014, a total of 15 male adults after hypospadias repairs, aged 18-24 years, underwent modified penile augmentation which involved girth enhancement by a free dermal-fat graft and penile elongation (suprapubic skin advancement-ligamentolysis). A specially designed tunneling instrument was introduced to facilitate pericavernous thickening without degloving. Outcome evaluation was mainly based on objective penile measurements and results of the Male Genital Image Scale. RESULTS: With 6 months' follow-up, all patients had achieved excellent cosmetic results, with a significant average dimensional increase of 1.53 ± 0.23 cm in flaccid girth and 1.67 ± 0.24 cm in flaccid length. No erection deficiencies or urinary fistula occurred. Patients' perception of male genitalia improved postoperatively, with the average MGIS score rising from 31.73 ± 4.86 to 40.20 ± 4.54. CONCLUSIONS: This modified technique is safe and effective in enlarging penile size. The use of the specially designed tunneling instrument simplifies penile girth enhancement, avoiding unnecessary trauma to the neo-urethra and neurovascular bundle. It is confirmed that physical dimensional enhancement does contribute to improving their underestimation of penile size. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

[Plasty method for penoscrotal transposition].

Objective: To investigate the plasty method for penoscrotal transposition and its efficacy. Methods: The adhesion between penis tunica albuginea and scrotum sheath capsule was separated to return the testis and their sheath capsule to the abdomen side of penis. Also, the scrotum skin was also transferred to the abdomen side of penis. The normal anatomic position of penis and scrotum was returned. Results: Between Jan 2004 to Oct 2015,34 cases were treated.5 scrotum fascia skin flaps underwent ischemia at the flap tip with delayed healing. All the other flaps survived with primary healing and good appearance. Conclusions: Adhesion between penis tunica albuginea and scrotum sheath capsule should be separated to return the testis and their sheath capsule, as well as scrotum skin to the abdomen side of penis. It' s an optional method for penoscrotal transposition.