Oral Mucosa vs. Penile Skin Flap in Substitution Urethroplasty for Anterior Urethral Strictures: A Systematic Review and Meta-Analysis

Background: The purpose of this study is to compare the effectiveness and safety of oral mucosa and penile skin flaps in the treatment of anterior urethral stricture.Methods: This meta-analysis was carried out according to the principle of preferred reporting items for systematic reviews and meta-analysis (PRISMA) and registered at PROSPERO (CRD42021277688). The Cochrane Library, PubMed, Embase, CKNI databases were searched and reviewed up to Sep 2021. Quality evaluation was performed with Newcastle-Ottawa Scale (NOS) system for non-randomized studies and Cochrane stools for randomized studies. Data synthesis was conducted with RevMan 5.4 software (Cochrane) and a Stata 15.0 environment (Stata Corpor, College Station, TX, USA).Results: After the research screening, eight studies (comprising 445 patients) were finally included in the quantitative analysis. In the success rate comparison, there was no significant difference between oral mucosa and penile skin flaps (oral mucosa vs. penile skin flap, Mantel-Haenszel statistic [M-H] fixed model, OR: 0.80, 95% CI: 0.47–1.34, P = 0.39). There was no significant difference in the post-operative complication comparison (oral mucosa vs. penile skin flap, Mantel-Haenszel statistic [M-H] fixed model, OR: 0.68, 95% CI: 0.40–1.16, P = 0.15). However, considering that the site of oral mucosa is far from the anterior urethra, it may have advantages in operation time through simultaneous operations (oral mucosa vs. penile skin flap, MD: −40.05, 95% CI: −79.42, −0.68, P = 0.046).Conclusion: When the oral mucosal graft was used in the anterior urethra urethroplasty, it had a similar success rate and post-operative complication rate, and oral mucosa substitution had a shorter operation time. This evidence-based medical research further supports the view that oral mucosa is the preferred substitution material for the anterior urethra urethroplasty.

Experience with Flaps After Resection of Vulvar Carcinoma: A Case Series

Background: A defect caused by the radical resection of vulvar cancer requires repair with flap transplantation or vulvoplasty. Therefore, the aim of this study is to present a review of our practice of post-surgical defect reconstruction in cases using different skin flaps.Methods: An observational study was performed among 26 patients with vulvar cancer who were admitted to Sun Yat-Sen Memorial Hospital between February 2015 and February 2020 for surgical and reconstructive procedures. Clinical data of these 26 patients were analyzed. All patients underwent radical resection of vulvar cancer, followed by the repair of post-surgical defects by random flap or axial flap transplantation (even for very complex defects).Results: Among the 26 cases in this study, all patients received 38 soft tissue reconstruction procedures for vulvar perineal defects during the study period. Squamous cell carcinoma was the most commonly diagnosed cancer (80.8%). The average size of the defect was 9.3 ´ 7 cm2. Rhomboid flaps were the most commonly used flaps for performing reconstruction in both the primary and recurrent groups. Poor wound healing was the most commonly discovered complication that occurred in 3 of the 38 flaps (7.9%) used. Previous surgery or radiotherapy did not increase the rate of complications after proper reconstruction was performed.Conclusion: Expanding resection is an effective technique for treating vulvar cancer. Different skin flaps, are effective premium options for post-surgical defect reconstruction, and selective use of skin flaps for treating vulvar defects preserves the vulvar morphology and allows for relatively better functionality.

THE USE OF BILATERAL DEEP INFERIOR EPIGASTRIC PERFORATOR FLAP (DIEP) IN BUTTOCK DEFORMITY RECONSTRUCTION - CASE REPORT

Buttock soft tissue defects can be encountered due to many causes and also have many treatment solutions. Usually, defects are common on one side of the buttocks and cutaneous skin flaps in place, local or regional used. The article analyzes a rather rare case with a soft tissue defect in the buttocks on both sides as a necrotic sequela after injecting fillers for cosmetic purposes. After treatment of necrotizing inflammation, the sequelae left behind is a concave scar and deformed buttock on both sides. The local fat flaps are not valuable in this case, while the free fat flap will face many risks of failure due to the use of 2 flaps on both sides, the post-operative care position is also very difficult, easy to cause tension, compress the vascular pedicles. This clinical case with the use of bilateral DIEP flaps, and the postoperative results in this case are analyzed and evaluated in the article.