Staged penile reconstruction with pedicled groin flap for penile shaft necrosis following circumcision

A 10-year-old boy was referred by urologist to plastic surgery department with penile shaft necrosis after debridement of necrotic tissue and dry eschar that extends from the glans to the penile root and was started to separate. Also, they managed to insert urethral catheter. He had traditional circumcision 2 weeks earlier performed at home by a traditional health practitioner, resulting in full-thickness tissue loss involving skin and corpora cavernosa with sparing of the glans which was attached by stalk of scared tissue enveloping the spongiosum. After assessment and analysis of the defect was done, two-stage pedicled groin flap reconstruction was performed with satisfactory results. In this report, we are demonstrating procedure steps and outcome.

Retrospective Study of 20 Patients that has Treated with Pedicled Groin Flap in Reconstruction in Hand Injuries

Pedicled groin flap has long been playing an important role in reconstructive hand surgery. This flap is a reliable method for closing the defects of the soft tissue loss of the hand and is used in many clinical conditions. This study aims to evaluate the epidemiology and geographic aspects of the patients that required the treatment with pedicled groin flap and to assess the outcomes achieved by the Children’s Surgical Centre to help guide the future practice. We studied of 20 patient that has treated with pedicled groin flap reconstruction of the hand injuries between 2009 and 2019 at the Children’s Surgical Centre, Kien Klerng, Phnom Penh, Cambodia. In this study pedicled groin flap was used in 20 patients aged between 7 to 56 years, with a mean of 31 years or 40 % of all patients. The sex ratio M/F was 1.5 which was 12 male patients (60 %) and 08 female patients (40 %). The main cause of patient hand defects was from contracture related to burn sequelae which is 70 %.

Utility of Groin Flap in Penile Reconstruction

Background: Reconstruction surgery for skin and soft tissue defects of the penis would ideally secure sufficient volume, be safe in procedure, and involve a simple surgical technique. Among the wide variety of techniques that have been employed, the groin flap-based technique is considered a relatively simple option for volumetric reconstruction. In this retrospective study, the authors report cases of penile reconstructive surgery using a groin flap.Methods: We performed a retrospective chart review of patients with penile defects treated in our department. Reconstructive surgeries were carried out using pedicled groin flaps. Charts were reviewed to investigate duration of the surgeries, recovery and follow-up periods, and bulkiness at one and 10 months after surgery. Patients were observed postoperatively for complications, urination, and erectile function.Results: Six patients hospitalized from March 2009 to September 2013 for penile defects underwent surgery in our department. All patients recovered without any flap loss. The most common complication after surgery was wound dehiscence. Circumferences of penile shafts were measured at 1 and 10 months after surgery, and penile bulkiness at rest were found to be maintained at >86%. There were no patients with contracture, and in all patients, urination and erectile functions were satisfactory.Conclusion: Reconstructing penile defects using groin flaps was found to be favorable in terms of volumetric reconstruction and postoperative patient satisfaction. Furthermore, the surgery and recovery periods are short, and rates of complication and donor site morbidity are also low.

Role of Ultrahigh Frequency Ultrasound in Evaluating Experimental Flaps

Background Experimental flap follow-up needs faster, safer, and less invasive techniques that can be easily correlated to clinical procedures. For this reason, we aimed to test the role of ultrahigh frequency ultrasound in follow-up of flap viability. Further on, we aimed to analyze if the chimeric groin flap can be mobilized in a sandwiched position without affecting its vascular supply by twisting its pedicle. Methods A total of 12 male Wistar rats, split into three groups, were used. Group A (n = 4) had the chimeric groin flap repositioned in a sandwich position on the anterior abdominal wall and underwent ultrahigh frequency ultrasound follow-up at days 10 and 14. Group B (n = 4) also had the flaps sandwiched, however, at day 14 the vascularity of flaps was proven by infusion of nontargeted ultrasound contrast agents, after which flaps were sent for histological analysis. Group C (C1 n = 2, C2 n = 2) was the control group. In C1 the chimeric groin flap was harvested and sent for histology on day 0, acting as a histological benchmark of flap viability, and in C2 the chimeric groin flap was re-sutured in its anatomical position and after 14 days, flaps were harvested and sent for histological analysis, acting as a direct control for Group B. Results Ultrasound showed constant vascular flow in both adipose and skin flaps in the sandwiched position. Microbubble study showed diffuse perfusion within flaps. Ultrasound measurements of flow velocity, flap volume, and percentage of vascularity showed a decrease in flap volume and increase in vascularity over 14 days. Histology showed similar viability in both groups. Conclusion Ultrahigh frequency ultrasound may be a valuable tool for postoperative flap assessment, while the chimeric flap can be moved freely in a sandwich position making it suitable for adding tissue substitutes within its components.