Modified Internal Pudendal Artery Perforator Flap Interposition for Rectovaginal Fistula.

IMPORTANCE: Rectovaginal fistula (RVF) is a challenging condition associated with recurrences and significant functional impairment. OBJECTIVES: The internal pudendal artery perforator (IPAP) flap has become a viable option for reconstructing the vagina and perineal regions. This study aims to introduce a modified technique of IPAP flap interposition and evaluate its postoperative outcomes in the treatment of low RVF. STUDY DESIGN: Sixteen patients with RVF who underwent modified IPAP flap interposition between 2016 and 2021 were retrospectively enrolled. Recurrence rate, the satisfaction of vulvar appearance (Visual Analog Scale), and quality of sexual life (Female Sexual Function Index score) were followed up and analyzed. RESULTS: All patients presented with low fistula with a mean diameter of 8.3 mm. The mean width and length of the IPAP flaps were 3.8 and 6.2 cm, respectively. The mean follow-up period was 14.1 months. All patients achieved successful healing without recurrence. High satisfaction was reported for the cosmetic effect of the vulva with a mean Visual Analog Scale score of 8.4. The proportion of female sexual disorder exhibited a statistically significant reduction, decreasing from 100% preoperatively to 38% after surgery (P < 0.05). CONCLUSIONS: The modified IPAP flap interposition is a reliable and safe option for repairing low RVF, with high success rates and minimal donor site morbidity. Moreover, this procedure provides a suitable volume flap and preserves the vaginal physiological environment, which benefits postoperative sexual function.

Transvaginal Posterior Levatorplasty Combined with Perineoplasty: An Effective Surgical Method for Vaginal Rejuvenation.

BACKGROUND: Recently, gynecological cosmetic surgery and rejuvenation surgery have become increasingly popular, with a surging vaginal surgery demand for female vaginal laxity. However, follow-up data on the effectiveness of such procedures remain limited. OBJECTIVE: We conducted a retrospective study aimed to investigate the effects of transvaginal posterior levatorplasty combined with perineoplasty on vaginal rejuvenation. METHODS: Forty-five patients, who underwent transvaginal posterior levatorplasty combined with perineoplasty between July 2020 and May 2022, were included. Patient characteristics before operation, at baseline, 3, 6, and 12 months postoperatively, questionnaires on patient symptoms, quality of life, and sexual function, including Vaginal Laxity Questionnaire (VLQ) and Female Sexual Function Index (FSFI) were evaluated. Pelvic ultrasound imaging was performed preoperatively and 3 months postoperatively. RESULTS: Mean vaginal capacity index and Vaginal laxity scores were different at baseline, 6, and 12 months postoperatively (p<0.01). Female sexual function including libido, sexual arousal, lubrication, orgasm, sexual satisfaction and pain were significantly improved (preoperative: 21.68±4.15; 6 months postoperatively: 26.88±2.44; 1 year postoperatively: 29.97±2.10; p<0.01). The symptoms of stress urinary incontinence (SUI) and recurrent vaginitis were improved in 78.6% and 90.5% of the patients, respectively. In pelvic floor ultrasound, retrovesical angle (RVA), urethral rotation angle (URA), levator hiatus (LH), and bladder neck distance (BND) were significantly different preoperatively and at 3 months postoperatively (p<0.01). Overall satisfaction was 93.3% at 12 months postoperatively. CONCLUSIONS: Transvaginal posterior levatorplasty combined with perineoplasty is effective for the improvement of patient symptoms, quality of life, sexual function, SUI, and postnatal constipation. Further research on the underlying mechanism is required. LEVEL OF EVIDENCE: Therapeutic, III.

The 50 most cited articles and science mapping analysis of vaginal tightening.

INTRODUCTION AND HYPOTHESIS: The study was aimed at exploring the 50 most cited articles related to vaginal tightening. METHODS: The papers were searched through the Thomson Reuters Web of Science on 30 July 2022, and were ranked by the total number of citations. The included articles were analyzed for author, journal, country, number of citations, keywords, subject matter, and level of evidence. The search output was also imported into VOSviewer. RESULTS: The 50 most cited articles were cited a combined total of 2,558 times. The papers were published between 1990 and 2020, of which 86% were published between 2010 and 2020. They included 38 original articles, 8 reviews, 3 editorial articles, and 1 letter. Most articles were published in gynecology-related journals (n=30, 60%). The articles covered a wide range of topics, the most common being laser/radiofrequency treatment, vaginal tightening procedures, and urinary incontinence. The majority presented findings supported by level IV or V evidence. Through co-occurrence analysis, high-frequency words and countries were displayed well. CONCLUSIONS: The study shed light on frequently read articles and influential topics about vaginal tightening. The highly cited literature mainly focused on laser or radiofrequency treatments and gynecologists currently dominate the highly cited literature on vaginal tightening. The articles related to surgical treatments are low in number and evidence level so far. The co-occurrence analysis reveals the hot research content and active countries in the field. In general, the study provides useful evidence for future research and educational materials.

Sub-regional skin grafting for perineal resurfacing after excision of superficial vulvar tumors: An excellent method to achieve an aesthetically pleasing appearance.

OBJECTIVE: To investigate the effect of sub-regional split-thickness skin grafting in perineal resurfacing. METHODS: A single-center retrospective study was conducted in the Genital Plastic Surgery Center. Detailed clinical data of 14 consecutive patients who underwent split-thickness skin grafting after vulvar tumor resection from February 2013 to June 2022 were analyzed. Clinical data, postoperative photographs, scoring of vulvar appearance, and questionnaire results of the Female Sexual Function Index before and after surgery were analyzed. RESULTS: The patients had sub-regional split-thickness skin grafting ranging from 7 × 8 cm to 11 × 12 cm (88.86 ± 24.99 cm2 ). After a follow-up of 8.21 ± 2.22 months (mean ± SD), all patients had a three-dimensional and aesthetically pleasing vulva and high scoring of vulvar appearance (mean ± SD, 4.43 ± 0.65). All patients had good healing of both the recipient and donor sites without major complications. Only one patient had minor dehiscence in the perineal region and recovered soon after proper treatment. The scores of the Female Sexual Function Index were significantly improved after surgery. Among the included domains, scores of "desire," "arousal," "orgasm" and "satisfaction" increased significantly after surgery (p value <0.05). CONCLUSIONS: Sub-regional split-thickness skin grafting could achieve excellent cosmetic outcomes with few complications in perineal reconstruction after the excision of superficial vulvar tumors. It can provide an aesthetically pleasing appearance in the vulvar region and improve female sexual function to some extent. In general, sub-regional split-thickness skin grafting could be a recommended reconstructive option to repair vulvar defects.

Trend of Academic Productivity in Plastic Surgery and the Impact of COVID-19: A Bibliometric Analysis.

BACKGROUND: Plastic surgery has grown rapidly over the past decade, with increasing scientific output. The emergence of coronavirus disease 2019 (COVID-19) has a considerable impact on plastic surgery. OBJECTIVE: To identify trends in published literature in plastic surgery from 2011 to 2021. To explore the impact of COVID-19 on scientific research output through bibliometric analysis methods. METHODS: Web of Science was searched by authors on December 23, 2021. Published papers about plastic surgery over the last decade were analyzed. The search output was imported into VOSviewer for science mapping. RESULTS: The actual number of papers related to plastic surgery during the COVID-19 period was higher than expected one. For scientific outputs in plastic surgery, keywords about surgical practice had a high frequency. "Reconstruction," "effect," "flap," "tissue," "defect," "model" maintained a high level of heat before and after COVID-19. The heat of "risk," "complication," "review," "infection," "cohort," and "meta-analysis" increased after the outbreak of COVID-19. The international collaboration showed an upward trend despite the impact of COVID-19. From the perspective of the volume of plastic surgery publications, some journals had a more positive performance compared to the pre-epidemic period. The proportion of original articles decreased after the spread of COVID-19 from 70.26% to 63.84%. CONCLUSION: Although the COVID-19 has a profound impact on the healthcare industry, the bibliographic data reveals an increasing scientific output in the field of plastic surgery over time. For plastic surgery, high-frequency terms, research hotspots, popular journals, article types, and international collaboration have changed under the influence of COVID-19.

Circumferential full-thickness skin grafting: An excellent method for the treatment of short penile skin in adult men.

Objective: Short penile skin due to excessive circumcision is a complex condition requiring surgical care. The study aims to investigate the effect of full-thickness skin grafting (FTSG) in treating short penile skin. Methods: A retrospective analysis was performed on 24 patients with insufficient penile skin. The included patients underwent full-thickness skin grafting from the scrotum and the groin region in the Genital Plastic Surgery Center between February 2014 and September 2021. Morphology of the penis, length of the penis, complication, and donor area healing status was observed by the authors. Additionally, the International Index of Erectile Function Questionnaire (IIEF-5) and the patient's evaluation of penile appearance were investigated. Results: An aesthetically pleasing appearance of the penis was obtained by FTSG in 24 patients. The length of penis was improved after surgery (5.70 cm ± 1.24 cm vs. 6.05 cm ± 1.33 cm, P value < 0.05). All patients had good healing of the penile area without serious complications. Only 2 cases showed minor partial necrosis and recovered soon after proper treatment. A high patient's evaluation of penile appearance was received (4.08 ± 0.71, mean ± SD) and the scores of IIEF-5 increased significantly after surgery (18.38 ± 2.24 vs. 21.08 ± 1.79, P-value < 0.05). Conclusions: FTSG from the scrotum and inguinal skin provides good aesthetic and functional results for treating short penile skin. FTSG, particularly the scrotum-derived skin graft, offers a great supplement to penile skin. It could be suggested as a promising method of treating insufficient penile skin, which meets both functional and aesthetic needs.

Trilobal Methods for Composite Reduction Labiaplasty.

BACKGROUND: It is difficult to plan a simple and effective surgical strategy for patients with horizontal and vertical redundant tissue of the labia minora and clitoral hood redundancy. A single edge resection or wedge resection labiaplasty with clitoral hood reduction that simultaneously resolves these three issues has yet to be reported. This study investigated the clinical effects and safety of trilobal labiaplasty via a composite incision. METHODS: The single-center, retrospective, observational study included data from patients with hypertrophy of the labia minora and clitoral hood who underwent trilobal labiaplasty. RESULTS: Altogether, 136 patients (average age: 31.6 ± 8.82 years; range: 21-53 years; 224 sides) sought surgery for aesthetic (39/136, 28.7%), functional (17/136, 12.5%), or both reasons (80/136, 58.8%). Overall, 134 patients (134/136, 98.5%) were followed up for 3 months. No serious complications or malformations occurred. Three patients (2.2%) underwent secondary repair surgery due to incomplete bilateral symmetry, 122 (91.0%) scored ≥ 21 points on the Female Genital Self-Image Scale, 107 (91.5%) were satisfied with the cosmetic outcomes, and 93 (95.9%) were satisfied with the functional improvement. CONCLUSIONS: Trilobal labiaplasty performed via a composite incision using edge and wedge labiaplasty to adjust horizontal and vertical hypertrophy of the labia minora and remove lateral folds of the clitoris is a safe and effective method to improve the appearance and rearrange the position of the clitoral hood and clitoral frenulum while preserving the fine structure of the surrounding tissue. This method results in few complications and high functional and aesthetic satisfaction rates. 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 .

Quantitative analysis of the labia minora morphology in 400 Chinese women: A new method for assessing the shape of the labia minora.

Purpose: To investigate the shape of labia minora in Chinese adult women. Methods: Women who visited the Genital Plastic Surgery Center from January 2021 to February 2022 were included and the vulvar regions were photographed. The shape of the labia minora was converted into quantifiable values [left side line segment 1-9 (L1-L9 values) and right side line segment 1-9 (R1-R9 values)]. The 400 enrolled patients were grouped by age, parity, and the types of vulvar surgeries they planned to undergo. Results: After a graphic-to-digital and digital-to-graphic conversion, the simulated average image of the labia minora in Chinese adult women was constructed based on the mean values of L1-L9 and R1-R9. Comparing the values of Ln and Rn in the four age groups revealed that the mean values of Ln and Rn gradually decreased with age, but only two subgroups showed statistically significant differences (P-value <0.05). When the patients were stratified according to the number of births and whether labiaplasty was planned to perform, there were no significant differences among all groups (P-value >0.05). Conclusion: To measure and evaluate the labia minora, a new assessing method was used. It is an innovative attempt to transform the simple rough description of the shape of the labia minora into more precise data reflecting the shape features. It allows the comparison of labia minora shape between individuals by comparing quantifiable values. Besides, the average shape of labia minora in Chinese adult women was provided visually. Factors including age, parity, and whether the patient planned to undergo labiaplasty were not significantly associated with the shape of the labia minora.

The complete mitochondria genome of Ravinia pernix (Diptera: Sarcophagidae).

Ravinia pernix is considered to be a forensically important fly species of the family Sarcophagidae. In this study, we present the complete mitochondrial genome of Ravinia pernix for the first time. There is one encoding region including 37 genes and one non-coding AT-rich region observed in the 15,778 bp circular genome, containing 13 protein-encoding genes, 22 transfer RNA genes and 2 ribosomal RNA genes. The arrangement of the genes is the same as that found in the ancestral arthropod. The base compositions of A, T, G and C are 39.57%, 37.60%, 9.36% and 13.47%, respectively. The mitochondrial genome of Ravinia pernix presented will be valuable and useful for enriching the dipteran mitochondrial genomes, resolving phylogenetic relationships within the family Sarcophagidae and the order Diptera, and providing a molecular tool for species identifications for forensic purposes.

The complete mitochondria genome of Sarcophaga africa (Diptera: Sarcophagidae).

Sarcophaga africa (S. africa) is a significant medical and forensic insect which belongs to the Sarcophagidae. The species identification of the forensically important genus Sarcophaga is difficult and requires strong morphology and taxonomic expertise. With the sequencing technique improved, we report the complete mitochondrial genome of the S. africa for the first time to assist species identification. The 37 genes presented in the 15,144 bp circular genome has been found which include 13 protein-coding genes, 22 transfer RNA genes, and 2 ribosomal RNA genes. The array of the genes has much resemblance with other discovered insects. The overall base compositions of A, G, C and T are 39.43%, 9.64%, 14.61% and 36.31% respectively. The complete mitochondrial genome of S. africa could be valuable to enriching the Dipteran mitochondrial genomes and be helpful for entomologists to screen reliable molecular markers in the species identifications with forensic entomology purposes or phylogenetic analysis.