The past decade has witnessed yet another rebirth in reconstructive surgery with the introduction of the so-called "perforator flaps". The demonstration of safe harvest of skin flaps based on dissection of cutaneous pedicles regardless of the course taken (through muscle or septum) has been revolutionary in allowing much greater choice in donor sites. Based on our experience in 1284 cases, the anterolateral thigh (ALT) region has proven itself to be an ideal donor site with reliable vascularity, ease of harvest and tremendous versatility. Inclusive in this flap is a large cutaneous territory, multiple components (adipofascial, muscle, fascia and skin) and possibility of chimeric applications. Although particularly useful in the head and neck (911 cases), the ALT flap was applied to reconstruct defects throughout the body. Donor site morbidity is limited as well. In short, the anterolateral thigh flap represents one of the most useful soft tissue flaps for free tissue transplantation.

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Spigelian hernias are rare and difficult to diagnose. Treatment has previously been limited to open surgical repair. We report the successful laparoscopic repair of bilateral spigelian and inguinal hernias using mesh.

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Neophalloplasty remains one of the most challenging efforts in plastic and reconstructive surgery. The complex functional and aesthetic requirements are difficult to attain with consistency and safety. The current gold standard technique involves the use of a radial forearm tube-in-tube free flap, which also requires the placement of a stiffening prosthetic device for dual function. We report the safe use of the free fibula osteocutaneous flap to create a functional, cosmetically-acceptable penis utilizing the principles of prefabrication and controlled fistula method in one case of gender dysphoria.