Background: Correction of male urogenital pathology of different severity is complicated by the anatomical aspects of the penis. Skin texture, internal structures, and perfusion dynamics of the urogenital area make it a difficult area to reconstruct. We provide our experience with axial scrotal flaps for correction of penile defects of different severity and believe that these local flaps offer sufficient tissue characteristics for proper restoration of this complex region. Methods: Forty-eight patients were divided into 3 groups depending on penile defect genesis and severity. Axial scrotal flap reconstruction was used for the correction of defects in all cases, when necessary in combination with other flaps. Results: Axial scrotal flaps for total and subtotal penile reconstruction serve as valuable material for reconstruction of the urogenital area, and are to be combined with other flaps for restoration of bulk tissues. Localized defects of the penis and urethra reconstructed by axial scrotal flaps provide excellent aesthetic results with minimal scaring, stable perfusion dynamics, and high satisfaction rate. Conclusions: Scrotal tissues provide an excellent reconstruction material for penile defects because of their highly similar tissue structure as that of the penis. Scrotal axial flaps do not provide excess bulking in the postoperative period and are recommended for reconstruction of urethral and localized penile defects. Multistage surgery is recommended in cases of severe tissue damage, in combination with other flaps (inguinal, thoracodorsal, and radial).
Summary: Aesthetic lower-extremity reconstruction is a secondary field in lower limb reconstructive surgery. Nevertheless, it plays an important role in the final stages of patient rehabilitation after traumatic events, treatment of deformations, and oncoplastic surgery, and in unique cases of purely aesthetic reconstruction. We present a clinical case of lower limb reconstruction with a prefabricated bipedicled deep inferior epigastric artery (DIEP) flap in a young patient who underwent a massive congenital circular pigmented nevus excision surgery. Due to the lack of sufficient donor site tissues anywhere on the body, a bilateral DIEP flap was prefabricated using tissue expansion. Two expanders were used to prepare the donor site. Six months after expansion, lower limb reconstruction was performed. A large (50 × 25cm2) surgical defect was covered by a prefabricated DIEP flap. Flap positioning was regarded with extra care due to importance of proper venous outflow in accordance with lower limb venous anatomy. Treatment results were above the satisfactory level both aesthetically and therapeutically. Aesthetic and therapeutic incentives were assessed before surgical treatment decision. Large defects of the lower limbs require significant amount of excess tissue in the donor site and may require prefabrication. In young patients with low BMI, flap transfer is nearly impossible without prior expansion. In this case, we successfully performed giant pigmented nevus excision, with immediate reconstruction with a prefabricated bilateral DIEP flap. Venous outflow was problematic due to the anatomical structure of lower limb veins. This required extra venous drainage and special regard to positioning of the flap.
In 2011, the staff of the Department of Plastic Surgery, Sechenov University (Moscow, Russia), organized three-stage microsurgical courses. Having analyzed the advantages and disadvantages of the previous practical course, it was created according to the principle “from simple to complex”, integrating theoretical material into the practical preparation for the formation of a microsurgical outlook.According to the authors, dividing the learning process into short-term stages allows students to gradually immerse themselves in the microsurgical world, while they themselves regulate the frequency of training and the need for further improvement of skills. Due to the phasing, the course becomes more accessible and makes it possible to popularize microsurgery as a universal method for solving surgical problems.
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