Background Lower limb reconstruction is a well-recognized challenge to the trauma or plastic surgeon. Although techniques and outcomes in the adult population are well documented, they are less so in the pediatric population. Here, we present our experience in the management of posttraumatic foot and ankle defects with free tissue transfer in children. Methods We performed a retrospective analysis of 40 pediatric patients between the ages of 3 and 16 from 2008 to 2016 who underwent foot and ankle soft tissue reconstruction. Any patient who underwent reconstruction for any reason other than trauma was excluded. Data were collected on operative time, free tissue transfer type, use of vein grafts, length of hospital stay, and postoperative morbidity. Also, a comprehensive systematic literature review was completed according to the PRISMA protocol for all previous reports of foot and ankle reconstruction in the young age group with free tissue transfer. Results Of our 40 patients, 23 were males and 12 females, free tissue transfer was used to reconstruct primarily the dorsum (71%), heel (11%), medial (9%), and lateral (3%) aspect of the foot. The anterior tibial artery was the predominant recipient vessel for anastomosis (77%). Mean inpatient stay was 9 days and our complication rate was 20%, primarily of superficial infection treated with antibiotic therapy. The review of the literature articles is completely analyzed in detail. Conclusion The need for durable coverage of exposed joints, tendons, fractures, or hardware makes the free flap particularly well suited to trauma reconstruction of the foot and ankle. The lack of underlying vascular disease in this patient group allows for low complication rates. Our study evidences the safety and positive long-term outcomes of free tissue transfer for the reconstruction of huge sized-soft tissue defects of the foot and ankle in children.

Background: Vascularized lymph node flap transfer is a recent approach used for the treatment of breast cancer-related upper limb lymphedema. Aim of the work:To evaluate the effect of vascularized lymph node transfer in the management of secondary upper extremity lymphedema. Patients and Methods: A prospective randomized clinical study was conducted including 30 patients stage II-III breast cancer-related lymphedema (BCRL) between December 2017 till June 2020. 15 patients underwent vascularized groin lymph node flap transfer (group B) using the axilla (n = 7) or distal placement (elbow/wrist) (n = 8) as a recipient site. 15 patients who were selected to undergo conservative therapy were used as controls. Intraoperatively, reverse lymphatic mapping using radioisotope or indocyanine green lymphography was performed to avoid iatrogenic lower extremity lymphatic injury. Outcomes were assessed using change of circumferential differentiation, volume reduction rate, and the change in episodes of cellulitis, pain, heaviness, and limb function. Results: At a mean follow-up of 30.07±2.6 months, the mean improvement of circumferential differentiation of group B (VGLNT) was statistically greater than that of group A (conservative physical therapy) (8.3 ± 2.7 percent versus 2.1 ± 4.6; P < 0.01). The evaluation of each treatment showed a significant reduction of infection rate in group B compared with group A (p < 0.001). Conclusion:Vascularized groin lymph node flap transfer using the axilla or distal forearm as a recipient site is an effective and reliable approach for treating breast cancer-related lymphedema.

Background:Facial burns represent between one-fourth and one-third of all burns. The long-term sequelae of periorbital burns include significant ectropion and lagophthalmos as a result of secondary burn contractures in the lower and upper eyelids, in addition to complete or incomplete alopecia of the eyebrows.Methods:A retrospective study of 14 reconstructive procedures for 12 postburn faces was conducted with all procedures performed since 2010 at the Department of Plastic Surgery, Al-Hussein University Hospital, and at the Craniofacial Unit, Nasser Institute Hospital. Four patients experienced chemical burns, and 8 patients experienced thermal burns. All patients underwent periorbital reconstruction using a bifurcated superficial temporal artery island flap to reconstruct the eyebrows, correct the lagophthalmos, and release the ectropion in both the upper and the lower eyelids. Two patients underwent bilateral periorbital flap reconstruction. The mean age of patients was 29 years, and the study was conducted on 8 males and 4 females. Patient satisfaction was assessed using a questionnaire completed by all patients postoperatively.Results:The complete release of both the upper and the lower eyelids was achieved in all cases, together with ideal replacement of brow hair; no complications were noted, apart from one case in which a loss of hair density in the new eyebrow was observed, combined with the partial loss of the flap in the lower eyelid. Patient satisfaction results were collected and assembled in a table.Conclusion:A bifurcated superficial temporal artery island flap is an innovative flap for reconstructing both burned eyebrows and eyelids.

Background: Unexplained infertility continues to be a health challenge irrespective of revolution in medical care. Endometriosis could be associated with infertility. However, its prevalence is underestimated, as it need laparoscopy for definite diagnosis. Aim of the work: To estimate the incidence of typical and atypical [subtle] pelvic endometriosis among women with unexplained infertility and chronic pelvic pain. Patients and Methods: A total of 100 patients with unexplained infertility [50 patients] and chronic pelvic pain [50 patients] who underwent diagnostic laparoscopy had been included in the current study. All were assessed clinically after full history taking and underwent ultrasound, then prepared for laparoscopy. The main outcome was laparoscopic and histopathologic diagnosis of pelvic endometriosis, and the association between endometriosis and different patient characteristics and other risk factors had been analyzed. Results: Endometriosis was diagnosed by laparoscopy in nearly 33 of patients included in this study of which 29 cases [12 with unexplained infertility and 17 with chronic pelvic pain] were confirmed by histopathologic examination. Thus, the final incidence of endometriosis was 29%. Development of endometriosis was significantly associated with positive family history, dysmenorrhea and higher CA125. Conclusion: Pelvic endometriosis is a frequent association with unexplained infertility and chronic pelvic pain. It should be considered in those women particularly when there was positive family history, dysmenorrhea or higher CA125.

The aim of this study is to compare the outcomes of resurfacing of postburn neck contractures with two free flaps; Para-Scapular free flap and free Antero-lateral thigh flap considering functional, aesthetic outcome, technical difficulties and donor site morbidity. Free flaps have been found to be a good single stage option for reconstruction of post-burn contractures of the neck. This is a prospective randomized comparative study that has been conducted in the period from January 2017 to May 2018 for 20 patients with postburn neck contractures. The patients have been randomly classified into 2 groups; group (A) patients were resurfaced by free anterolateral Thigh flap group (B) patients were resurfaced by parascapular free flap. Results revealed improved functional and aesthetic outcome at recipient site. Moreover, Parascapular free flap has better aesthetic outcome regarding donor site scar and required secondary procedures for debulking less than free ALT flap.On the other hand, ALT flap favors two teams' approach and avoid changing position of the patient during surgery.