Microsurgery最新文献

Fournier's gangrene often leads to extensive perineogenital soft tissue loss, necessitating complex reconstruction. The superficial circumflex iliac artery perforator (SCIP) flap is known for its thin pliable skin and low donor site morbidity. We present a case of a 65-year-old male with Fournier's gangrene affecting both the mons pubis and scrotum. After multiple debridements, a double-paddle SCIP flap based solely on the superficial branch of the SCIA was designed with two independent skin paddles to reconstruct these adjacent but anatomically distinct areas. Preoperative CT angiography and intraoperative SPY imaging enabled flap design and ensured vascular reliability. A double-paddle SCIP flap was elevated with two skin paddles, each inset to separate regions. Through proximal-to-distal dissection, the superficial circumflex iliac artery and its superficial branch were identified and dissected. Upon confirming the origin of the arterial branching of the superficial branch, two flaps were designed—one superiorly and one inferiorly positioned—measuring 14 × 7 cm and 8 × 5 cm, respectively, with an approximate thickness of 10 mm and a pedicle length of 8 cm. The total operative time was approximately 55 min. Postoperative recovery was uneventful, with satisfactory healing and aesthetic outcome at 6 months. This case illustrates a novel use of a double-paddle SCIP flap based exclusively on the superficial branch of the SCIA to simultaneously reconstruct two separate anatomic regions affected by Fournier's gangrene. This approach provides a single-donor, dual-target solution that is both reliable and aesthetically favorable.

Penile skin reconstruction is traditionally performed using a skin graft and/or local pedicled flap. The scrotal flap is one of the options. However, previous techniques sacrifice the bilateral external pudendal arteries which put the skin pedicle at risk of dyspareunia and stretching. To overcome this limitation, we used the external pudendal artery perforator (EPAP) hemi-scrotal flap with isolation of the pedicle perforator to elevate the perforator flap with a wider rotation arc, easier and safer inset without tension, and sufficient coverage of the defect. A 40 years old male with schizophrenia had circumferential penile skin defect after penile replantation. The sensate EPAP hemi-scrotal flap measuring 9 × 14 cm was designed using doppler ultrasound preoperatively and harvested above the deep fascia. The external pudendal artery perforator and the anterior scrotal nerve were isolated. The shaft skin defect was covered with the sensate EPAP flap and the donor site was closed primarily. Postoperative course was uneventful without any short-term complications. Seven months after the reconstructive surgery, the transferred flap showed good color match and sensation, and the donor site was inconspicuous. Its function recovered without the sensation of pain and stretching. According to current literature the scrotal flap is a suitable donor site because of its thin, pliable, pigmented, and sensate characteristics. Beyond this current approach, we believe that harvesting the scrotal flap specifically as a perforator flap may be a superior flap for penile skin coverage. A higher rotation arc and inconspicuous donor site scar are further beneficial features of this approach.

The deep inferior epigastric perforator (DIEP) flap remains the preferred flap option for autologous breast reconstruction following mastectomy. This case report presents the novel use of the cephalic vein (CV) as an interposition graft to alleviate venous congestion in a patient undergoing DIEP flap reconstruction. A 42-year-old woman experienced venous congestion following her initial autologous reconstruction, attributed to thrombus formation from kinking of the vascular pedicle. Despite initial attempts to resolve the congestion, the condition persisted. Since the flap was based on a single perforator, we decided to attempt a CV turndown. The CV was noted to be attenuated and not feasible for use in turndown; therefore, venous salvage was completed by using the CV as an interposition graft to bypass the affected flap vena comitans. The procedure successfully restored venous flow, allowing for flap salvage and subsequent healing. This case underscores the potential of CV as an interposition graft in autologous breast reconstruction, particularly when traditional CV turndown is not possible due to vessel attenuation.