Background:The purpose of this study is to decrease the incidence of venous congestion occurring in the reversed flow posterior interosseous artery flap used for coverage of hand defects.Methods:This may be achieved by studying the incidence of venous congestion in flaps including only 1 perforator and comparing the results with others including more than 1 perforator both in small and large sized flaps.Results:This study showed that inclusion of only 1 perforator in the flap decreased the incidence of venous congestion with complete flap loss in flaps to 5%. Also, it decreased the incidence of venous congestion with partial flap loss in flaps to 10%.Conclusions:The small sized reversed flow posterior interosseous artery flap should be less than 40 cm2 and should include only 1 perforator to decrease the incidence of venous congestion with partial and complete loss of the flap. The level of evidence for this study is the type II prospective comparative study.

The reversed radial forearm flap is considered the workhorse flap for hand reconstruction, while the posterior interosseous artery (PIA) flap did not take the same interest. This paper presents 25 cases with ulnar side hand defects that was reconstructed with PIA flap with 22 flaps survived (88%). The PIA flap seems a good option and should be considered as another option for hand coverage when the surgeon prefers not to use free tissue transfer or the radial artery flap. The flap should be learned to senior and junior reconstructive surgeons, because familiarity with the flap anatomy lessens the operative time greatly and makes surgical dissection easier.

Huge upper limb defects poses difficulty due to its length and need of thin skin flaps allowing tendon gliding and durable coverage. Many reliable flaps have been described either pedicled local, regional, distant pedicled or free flaps. The lower abdominal flap based on the superficial circumflex iliac and superficial inferior epigastric vessels; branches of the superficial femoral systems on both sides that were divided sequentially from the abdomen due to its robust size to avoid vascular compromise of the flap. The flap survived completely with good adherence and coverage. The donor site was closed primarily with very minimal donor site morbidity. In conclusion; bilateral combined groin and hypogastric flap may be useful in extremely huge combined skin defects on the hand, forearm and the elbow with high reliability and safe.

Background:The incidence of thrombotic manifestations during aesthetic procedures may be overwhelming, as it may endanger patients' lives. Lipoabdominoplasty is one of the precarious aesthetic treatments with risk for thrombosis. COVID-19 convalescent patients may have an abnormally high rate of thrombotic events, which should be studied further. Patients with a history of COVID-19 infection who undergo the aesthetic procedure may have a greater risk of thrombosis than non-COVID-19 patients who undergo lipoabdominoplasty. Methods: Thirty-seven patients who underwent lipoabdominoplasty were followed retrospectively for the occurrence of thrombotic events postoperatively and their relationship to previous COVID-19 infection. The study design comprised an examination of their medical records for prior COVID-19 infection, a history of thrombotic events before, during, or following COVID-19 infection, and D-dimer levels during and after COVID-19 infection. Thrombotic signs were studied in COVID-19 convalescent and non-COVID-19 patients following lipoabdominoplasty. The universal prophylactic measures for anticoagulation were followed. Results: Four patients out of 37 (10.18%) had thrombotic manifestations, with a high incidence in the COVID-19 convalescent group. The occurrence rate in COVID-19 patients was 30.7%, much higher than the global rate (0.2%). The presence of D-dimers was discovered to be abundant. Conclusion: Additional precautions should be taken to closely monitor patients with a prior history of COVID-19 infection who seek aesthetic surgery, particularly riskier procedures such as lipoabdominoplasty.

Background: Crushing injuries of the lower 1/3 of the lower limb always represent a challenge for reconstruction. Reconstructive options diminish with the injury of one or more of the major vessels of the lower limb. This is a revisit of distally based medial hemi-soleus muscle flap as a valuable option in such reconstruction.Patients and Methods: 16 patients with skin loss over lower one third of leg of various causes had pre-operative duplex done to detect affection of anterior tibial and/or peroneal vessels and confirm patency of the posterior tibial vessels. CT angiography was done for confirmation. In case of one or two vessels affection, sparing the posterior tibial artery, the defects in the distal one third of the leg were reconstructed by distally based hemi-soleus muscle flap; based on the distal perforators of the medial head of the soleus muscle from the posterior tibial artery. Results:The flap survived completely in twelve cases with total loss in one patient, partial loss in two case and local recurrence of the excised tumour in one case. Conclusion:The distally based medial hemi-soleus muscle flap is a very good option in reconstruction of problematic lower one third skin defects especially that associated with vascular injury other than the posterior tibial vessels.

Background: Use of fascio-cutaneous or fascial flaps are well known methods of reconstruction of dorsal hand defects to preserve the gliding movement of the extensor tendons. Whilst reconstruction of large hand defects extending to the wrist or the distal forearm entails use of larger flaps with large donor sites, so muscle flaps may have an advantage over the fascial or fascio-cutaneous flaps in coverage of these large defects. The aim of this study is to compare the gliding of the extensor tendons underneath fascio-cutaneous and muscle flaps on the dorsum of the hand. Patients and Methods: The study included 20 patients with dorsal hand trauma with exposed extensor tendons, ten defects were reconstructed by free muscles flap and split thickness skin graft and the other ten were reconstructed with fascio-cutaneous flaps. Early rehabilitation in all cases was done by a single dedicated physiotherapist. Tendon gliding was assessed by measurement of active flexion and extension at the metacarpo-phalangeal joint using goniometer after complete flap healing four months following flap inset. Results: There was no statistically significant difference in gliding for extensor tendons in patients with hand defects reconstructed by free muscle flaps and skin graft versus fasciocutaneous flaps. Conclusion: Both fascio-cutaneous and free muscle flaps had comparable results concerning the extensor tendons gliding underneath.

Background: The inferior pedicle is still the most common pedicle used for breast reduction using both inverted T and vertical closure, however many unfavorable results may follow as bottoming out and decreased upper pole fullness. Many techniques were done to overcome the drawbacks of the inferior pedicle technique.Patients and Methods: 10 patients complain of huge ptotic breast had inferior pedicle technique with full release of pedicle from skin with glandular brassiere support in form of lower pillars on both sides with vertical skin closure.Results: Satisfactory long term results both objectively and subjectively, with good upper pole fullness and without bottoming out and only with vertical scar.Conclusion: This technique combined both the merits of the inferior pedicle reliability and better aesthetic results.

Background Hypospadias is one of the most common congenital anomalies affecting males worldwide, with distal variants representing up to 70% of all cases. Several surgical techniques are adopted for distal hypospadias repair. However, there is still much controversy about the ideal technique. Objectives The aim of this study is to compare between the most popular reconstructive techniques for distal penile hypospadias repair. Highlighting their effectiveness, in term of success rate as well as the risk of postoperative complications. Methods For this systematic review, PubMed/Medline and ScinceDirect online databases were searched using the keywords ‘distal hypospadias, complications and outcome’. Inclusion criteria were primary repairs; distal hypospadias; pediatric case series and standard techniques. Abstracts of articles identified were reviewed, and then relevant articles were retrieved in full. Papers were only included if data on at least one of the main outcome measures was obtainable, which are postoperative fistula, meatal stenosis and glanular dehiscence. Data were pooled using CMA software, effect sizes were reported as event rates with 95% confidence intervals (CI) been calculated for each outcome. Results A total of 25 studies, which included 4572 patients, met the inclusion criteria. The tubularised incised plate (TIP) was the most commonly adopted procedure followed by the peri-meatal flap (Mathieu). Few studies reported data for other techniques like onlay flap, Thiersch-Duplay, meatal advancement and MAGPI procedures, in addition to urethral mobilization technique. The overall incidence of main complications was 10.5% with comparable results among different techniques. The results are in favor of urethral mobilization and TIP procedures over Mathieu regarding the incidence of both meatal stenosis and post-operative fistula. Overall, the quality of the included studies was determined to be satisfactory. Conclusion Compared with Mathieu technique, urethral mobilization and the TIP procedure for distal penile hypospadias (DPH) reconstruction were associated with a lower risk of overall complications specifically postoperative fistula and meatal stenosis.