Scalp reconstructive flaps

Scalp reconstruction requires keen insight into underlying anatomy and surgical armamentarium. The reconstructive surgeon must consider a plethora of complexities to devise a safe and cosmetically maximized outcome. The purpose of this article is to review scalp reconstruction techniques and the current literature in the framework of the reconstructive ladder, with special emphasis on local flap consideration, design, and execution.

Diagnosis and treatment of anterior urethral strictures in China: an internet-based survey

Background To investigate the current diagnostic and therapeutic approaches to anterior urethral strictures of Chinese urologists and to compare with developed countries and the American Urologic Association guidelines. Methods Anonymous questionnaires were distributed to members of Official Wechat Account of urology from March 19, 2020 to April 10, 2020. Descriptive and multiple correspondence analysis were used to analyze the data. Results A total of 1276 online questionnaires were received. The response rate was 21.7% (1276/5878). The most common diagnostic methods for anterior urethral stricture were urethrography (90.7%) and urethrocystoscopy (85.4%), while urethral dilation (92.3%) and internal urethrotomy (60.1%) were the main therapeutic procedures. End-to-end urethroplasty (45.2%) was the most common open surgery, followed by skin flap urethroplasty (14.9%) and free graft urethroplasty (12.4%). 76.2% of urologists used urethroplasty only after the failure of minimally invasive surgery (reconstructive ladder treatment strategy). Furthermore, middle-aged or elderly urologists who had attended trainings, had senior practice roles, and who utilized a reconstructive ladder treatment approach were most likely to perform urethroplasties. Conclusions Anterior urethral stricture treatment in China is still dominated by minimally invasive surgery, with most urologists using the reconstructive ladder treatment strategy. In general, the overall diagnostic and therapeutic strategies were similar between China and developed countries, with some deviations from the American Urologic Association guidelines.

The Role of Free Tissue Transfers for Defect Coverage over the Body in Geriatric Populations

The treatment of soft tissue defects in multimorbid frail patients requires optimized preoperative and perioperative management with a differentiated interdisciplinary approach. Preoperative assessment with established scores, such as the ASA score, is important in order to stratify the operative complication risk. Following the reconstructive ladder is important to avoid unnecessary long operations and consecutively higher operative risks. In cases where a free flap procedure is needed, infections should be treated properly, and vascular status and coagulation should be optimized before performing a free flap procedure. Attention should be paid to maintain independency, functionality and quality of life while choosing the best treatment option.

Diagnosis and Treatment of Anterior Urethral Strictures in China: An Internet-Based Survey

Background To investigate the current diagnostic and therapeutic approaches to anterior urethral strictures of Chinese urologists and to compare with developed countries and the American Urologic Association guidelines. Methods Anonymous questionnaires were distributed to members of Official Wechat Account of urology from March 19, 2020 to April 10, 2020. Descriptive and multiple correspondence analysis were used to analyze the data. Results A total of 1276 online questionnaires were received. The response rate was 21.7% (1276/5878). The most common diagnostic methods for anterior urethral stricture were urethrography (90.7%) and urethrocystoscopy (85.4%), while urethral dilation (92.3%) and internal urethrotomy (60.1%) were the main therapeutic procedures. End-to-end urethroplasty (45.2%) was the most common open surgery, followed by skin flap urethroplasty (14.9%) and free graft urethroplasty (12.4%). 76.2% of urologists used urethroplasty only after the failure of minimally invasive surgery (reconstructive ladder treatment strategy). Furthermore, there were significant differences in age (P < 0.01), practice role (P < 0.01), hospital location (P < 0.01), treatment strategy (P < 0.01), management (P < 0.01), and number of urethroplasties (P < 0.01) between urologists who had attended training or not. Middle-aged or elderly urologists who had attended trainings, had senior practice roles, and who utilized a reconstructive ladder treatment approach were most likely to perform urethroplasties. Conclusions Anterior urethral stricture treatment in China is still dominated by minimally invasive surgery, with most urologists using the reconstructive ladder treatment strategy. In general, the overall diagnostic and therapeutic strategies for anterior urethral strictures were similar between China and developed countries, with some deviations from the American Urologic Association guidelines.

Palmar Resurfacing of the Hand With Porcine Urinary Bladder Extracellular Matrix Following Traumatic Injury

Introduction. Complex wounds of the hand often result in soft tissue defects that are not amenable to primary closure, vacuum-assisted closure, or tissue expansion. Injuries presenting with large defects involving multiple levels of tissue must be addressed by using techniques at higher rungs on the reconstructive ladder, such as split-thickness grafting, pedicled flaps, or free flaps. When repairing palmar tissue, these techniques fall short due to their failure to approximate structure and function of specialized skin. More recently, dermal substitutes containing a decellularized extracellular matrix (ECM) have been used in reconstruction of soft tissue defects, acting as a structural scaffold for the regrowth of native cells. Extracellular matrix products have been shown to improve functional and sensory outcomes in areas requiring highly specialized skin. Urinary bladder matrix (UBM), a porcine ECM scaffold, is unique in that it contains an intact epithelial basement membrane that promotes more organized regrowth through layered structure. Case Report. This case presents a novel use of this product in resurfacing 80% of a palm after postoperative necrosis following a table saw injury to the right volar palm at the distal crease. The patient had intact sensation and near normal functional outcomes at most recent follow up. Conclusions. The UBM may be a valuable adjunct to achieve soft tissue coverage in large, complex hand wounds, particularly those involving the palmar surfaces.