Repair of necrosis and defects of penile skin with autologous free skin flap

We described a 27-year-old case of avulsion and traumatic degloving of penile with extensive penis skin necrosis. Under general anesthesia, donor skin was partially resected from lower limbs according to defect area of penile skin. Then shear the shape of graft was sheared, sutured to hostage skin defect and enswathed with tension. The postoperative appearance and function of the penis were satisfactory. It is suggest the homologous free skin flap from lower limbs is suitable for penile skin repair and beneficial to patient resulting in satisfactory erection and shape.

Efficacy of autologous conjunctival flap on repairing the late-onset filtering bleb leakage

AIM： To evaluate the effectiveness of autologous conjunctival flap surgery for repairing the late-onset filtering bleb leakage after trabeculectomy.METHODS： This study retrospectively reviewed 106 eyes from 106 patients with late-onset filtering bleb leakage after trabeculectomy who received autologous conjunctival flap surgery at the Zhongshan Ophthalmic Centre from 2005 to 2015. The basic information was recorded, and the interval time between trabeculectomy and autologous conjunctival flap surgery as well as related risk factors, intraocular pressure（IOP）, anterior chamber depth（ACD） and best corrected visual acuity（BCVA） were analysed. Moreover, 41 patients who completed the 1-year follow up were analysed to determine the IOP and BCVA changes and long-term success rates.RESULTS： The 50 male and 56 female subjects（average age 39.13±17.96 y） included 47（44.34%） and 33（31.13%） cases of primary open angle and primary angle-closure glaucoma. The mean interval between trabeculectomy and repair surgery was 60.60±56.92（3-264）mo. The mean mitomycin（MMC） concentration during trabeculectomy was 0.27±0.04（0.12-0.4） mg/m L in the fornix-based conjunctival flap group（68 patients） and 0.28±0.04（0.20-0.33） mg/m L in the limbal-based conjunctival flap group（11 patients）. After bleb leakage, the patients＇ vision remained stable while the IOP decreased from 10.25±4.76（3-20.86） to 9.44±4.33（2-21） mm Hg（P〈0.01）. In the 41 analysed patients, the IOP was controlled at 15.68±5.11（7-40） mm Hg in the 1^（st） year after autologous conjunctival flap surgery and recurrence was not observed, for a long-term success rate of 100%. CONCLUSION： Autologous conjunctival flap repairing surgery is an effective technique for sealing filtering bleb leakages and controlling IOP postoperatively.

Mitigating the impact of skin necrosis in reconstruction after nipple-sparing mastectomy

Skin flap necrosis is a common postoperative complication after breast reconstruction,with an incidence of up to 43.4%among patients undergoing nipple-sparing mastectomy.Necrosis can adversely impact aesthetics due to the need to excise nonviable tissue,and increase the risks of infection,implant loss,nipple-areola complex sacrifice and malposition.Patient-specific factors including age,body mass index,and breast size may affect the risk of necrosis.Mastectomy and reconstruction techniques(i.e.,choosing between skin-and nipple-sparing mastectomy,and between autologous and alloplastic reconstruction)may also influence necrosis rates.Intraoperative measures such as indocyanine green angiography and autologous skin banking,and the postoperative use of nitroglycerin paste for high-risk patients and warming blankets for autologous reconstruction are methods to help prevent and minimize the morbidity of skin necrosis.Herein,we share our institution’s approaches to predicting and mitigating skin necrosis,and methods of optimizing outcomes for breast reconstruction patients.

Complications in microsurgical breast reconstruction:thrombosis prevention and management

Breast reconstruction is one of the largest components of plastic and reconstructive surgery.Autologous free flap breast reconstruction continues to grow due to exceptionally high flap success rates.It provides patients with a durable and natural reconstruction with high patient satisfaction.A patent microvascular anastomosis is a key component to a successful autologous free flap breast reconstruction.Thrombus within the vascular anastomosis or the distal flap microcirculation is the most common cause of flap failure.This review aims to discuss microsurgical techniques including atraumatic handling of vessels,appropriate magnification,suture styles,anastomotic techniques,recipient vessel selection,the role of anticoagulation and antiplatelet therapy used to minimize the risk of thrombotic events.When microvascular thrombus occurs,early reoperation and reperfusion is imperative to flap survival.This review will discuss specific maneuvers and intraoperative interventions to maximize flap salvage.