Urethral reconstruction is a problematic issue, thus its management can be challenging. Different methods using various materials were introduced for urethral reconstruction. The authors have made some changes in the groin flap surgery, affording more successful urethral reconstruction for defects of long urethra and penile soft tissue. A 45-year-old male requested both functional and cosmetic reconstruction of his defected penis, caused by an iatrogenic urethral injury and chronic infection following removal of paraffin self-injected on the penile shaft. The defect affected the full length of the penile urethra, corpus spongiosum, and prepuce. A groin flap was designed, measuring 28×10 cm. The most distal flap was utilized for the construction of the luminal surface of the neourethra; relaxed length measuring 8 cm, and the lumen wide enough. Competent external meatus and neourethra was confirmed by retrograde cystogram and the patient voided with sufficient urine caliber up to 2 years follow-up. This operative technique has advantages. Donor sites have non-hair bearing skin for the neourethra and minimal or almost not-recognizable donor site morbidity. After surgery, the patient was relieved from voiding difficulties combined with psychological stress. The author would like to introduce a unique approach for the urethral and ventral phalloplasty using the groin flap.
Follow-Up Studies ; Genitalia ; Groin* ; Humans ; Male ; Middle Aged ; Paraffin ; Penis ; Phenobarbital ; Skin ; Stress, Psychological ; Tissue Donors ; Urethra

Any types of burn injury that involve more than deep dermis often require reconstructive treatment. In gluteal region, V-Y fasciocutaneous advancement flap is frequently used to cover the defect. However, in case of large burn wounds, this kind of flap cannot provide adequate coverage because of the lack of normal surrounding tissues. We suggest V-Y adipofascial flap using the surrounding superficially damaged tissue. We present the case of a patient who was referred for full-thickness burn on gluteal region. We performed serial debridement and applied vacuum-assisted closure device to defective area as wound preparation for coverage. When healthy granulation tissue grew adequately, we covered the defect with surrounding V-Y adipofascial flap and the raw surface of the flap was then covered with split-thickness skin graft. We think the use of subcutaneous fat as an adipofascial flap to cover the deeper defect adjacent to the flap is an excellent alternative especially in huge defect with uneven depth varying from subcutaneous fat to bone exposure in terms of minimal donor site morbidity and reliability of the flap. Even if the flap was not intact, it was reuse of the adjacent tissue of the injured area, so it is relatively safe and applicable.
Burns* ; Buttocks* ; Debridement ; Dermis ; Granulation Tissue ; Humans ; Negative-Pressure Wound Therapy ; Skin* ; Subcutaneous Fat ; Tissue Donors ; Transplants* ; Wounds and Injuries

In cases of replantation, accurate closure of all structures, including bone, tendons, arteries, nerves, and veins is essential. Among these, the vein is a weaker structure and is damaged severely in most amputation cases. After fixation of bone, repair of tendons, nerves, and arteries, surgeons often experience difficulty in performing venous anastomoses. We found that in such cases, venous anastomosis is easy to perform using an additional incision after closure of the original wound. In a 33-year-old male patient with amputation of all four fingers at the metacarpophalangeal joint level, venous anastomoses were performed with dorsal veins using additional incisions after completion of the fixation of bones and repair of all other structures and closure of the skin due to surgical site tension.
Adult ; Amputation ; Arteries ; Fingers ; Humans ; Male ; Metacarpophalangeal Joint* ; Replantation* ; Skin ; Surgeons ; Tendons ; Veins* ; Wounds and Injuries*

PURPOSE: In recent decades, amputation is still recommended for patients with extensive lower extremity wounds requiring coverage. Although the feet contribute relatively little to total body surface area, they are essential organ for ambulation, and a high mortality rate after amputation has been reported. We report on 10 challenging cases of a mangled foot which was reconstructed using an anterolateral thigh (ALT) free flap, and analyze the advantages and disadvantages of this technique. MATERIALS AND METHODS: This retrospective study was conducted on 10 patients who underwent reconstructive surgery on a foot. Patients' charts were reviewed for age, sex, causes, defect size and site, flap size and type, flap type, and complications. Cases with a defect size of >100 cm2 were included. RESULTS: Seven of the 10 patients were male, and overall mean age was 38.5 years (range, 22 to 61 years). Mean defect size was 179.6 cm2 (range, 104 to 330 cm2), and mean flap size was 193 cm2 (range, 120 to 408 cm2). Three cases were reconstructed with a musculocutaneous free flap and seven cases were reconstructed with a fasciocutaneous free flap. There were two occurrences of local wound complication. All ten flaps survived well, however five patients underwent a debulking procedure to reduce flap volume. CONCLUSION: Reconstruction of a near completely degloved soft tissue defect or a wide defect containing two or more surfaces of extremity with an ALT free flap was performed. The purpose of this case study is to report on free tissue transfer using the ALT flap for salvage of the lower extremity.
Amputation ; Body Surface Area ; Extremities ; Foot Injuries ; Foot* ; Free Tissue Flaps* ; Humans ; Lower Extremity ; Male ; Mortality ; Retrospective Studies ; Soft Tissue Injuries ; Thigh* ; Walking ; Wounds and Injuries

PURPOSE: The external ear is a common area of trauma on the body prone to exposure of ultraviolet light, which can lead to skin cancer. Thus, variable techniques have been developed and used for reconstruction of the external ear. The aim of this study is to review the surgical method, its area of application, as well as advantages and pitfalls of reconstruction of the external ear with inferior based retroauricular flaps. MATERIALS AND METHODS: Eight patients underwent external ear reconstruction with inferior based retroauricular flap for external ear defects in our institute from September 2012 to June 2015. According to the area of the defect, patients were classified as middle 1/3 (n=4), inferior 1/3 (n=2), superior auroculo-cephalic sulcus (n=1), and external auditory canal (n=1). RESULTS: All of the flaps survived the operation and there was no marginal necrosis. Mean size of the defect was 2.8×1.8 cm and mean size of the retroauricular flap was 5×2 cm. For insetting of the flap, a subcutaneous tunneling technique was used in 6 cases and rotation without subcutaneous tunneling was used in 2 cases. Transient paresthesia occurred in 3 cases. Two cases recovered within 3 months but one case did not recover until 6 months. CONCLUSION: The inferior based retroauricular flap is an available technique in external ear reconstruction with one stage operation.
Arteries* ; Ear Canal ; Ear, External ; Humans ; Methods ; Necrosis ; Paresthesia ; Skin Neoplasms ; Ultraviolet Rays

Old post burn contractures on feet still remain challenging problem for reconstructive surgeon. A 43-year-old male visited Hallym University Sacred Heart Hospital with the complain of foot deformity and difficulties in shoe fitting. His right 4th and 5th toes were inverted at dorsal foot. We released the contracture of 4, 5th metatarsophalangeal joint and lengthened extensor tendon by Z-plasty, and covered the resultant defect with the anterolateral thigh flap. The flap was successful and the deformity was corrected. As there have been few reports on reconstruction of foot dorsum, especially on post burn extension contractures in the toes, we report a rare case of contracture release and coverage by free flap.
Adult ; Burns* ; Congenital Abnormalities ; Contracture* ; Foot ; Foot Deformities ; Free Tissue Flaps* ; Heart ; Humans ; Male ; Metatarsophalangeal Joint ; Shoes ; Tendons ; Thigh ; Toes*

The neuroma is a tumor of nerve tissue that partially or completely severed through incomplete regeneration process. Neuromas that formed in the stump of a limb following amputation is a cause of the stump pain and can make intractable pain. The authors report a rare case of 36-year-old man with neuroma at stump, which has been recurred three times. This patient was treated with end-to-end neurorrhaphy after resecting neuroma. Follow-up at out-patient clinic showed satisfied result.
Adult ; Amputation* ; Extremities ; Follow-Up Studies ; Forearm* ; Humans ; Nerve Tissue ; Neuroma* ; Outpatients ; Pain, Intractable ; Regeneration

If the replantation on the original position is not possible, the amputated tissue of a hand may be used as a donor for recovering hand functions at other positions. This procedure is termed 'heterodigital replantation'. An 63-year-old male patient who was in press machine accident came to our hospital. He had large dorsal soft-tissue defects (5x3 cm) on his left long finger and complete amputation on his left index finger through the proximal interpharyngeal joint. Replantation was not indicated because crushing injury of index finger was severe. So we decided to use index finger soft tissue as heterodigital free flap for the coverage of the long finger defect. The ulnar digital artery and dorsal subcutaneous vein of the free flap were anastomosed with the radial digital artery and dorsal subcutaneous vein of the long finger. The heterodigital free flap provided satisfactory apperance and functional capability of the long finger. The best way to treat amputation is replantation. But sometimes surgeon confront severely crushed or multi-segmental injured amputee which is not possible to replant. In this situation, reconstructive surgeons should consider heterodigital free flap from amputee as an option.
Amputation ; Amputees* ; Arteries ; Fingers* ; Free Tissue Flaps* ; Hand ; Humans ; Joints ; Male ; Middle Aged ; Replantation ; Tissue Donors ; Veins

Neurofibroma may present as a solitary lesion or as multiple lesions. Although there is no site of predilection for solitary lesions, occurrence on the hand is rare. Plexiform neurofibroma can develop in isolation or more commonly as a part of neurofibromatosis type 1. In those that apper in isolation, trauma has been suggested as a precipitating factor. A 68-year-old male farmer had experienced repetitive prior episodes of trauma in the involved finger. He presented with a painless mass on the dorsal aspect of the fifth finger. Physical examination showed a protruding mass measuring approximately 15x20 mm which was not tenderness to palpation and any skin changes or pigmentation. Ultrasonography showed a cystic mass on the dorsal aspect of the middle phalanx. Microsurgical dissection was applied in order to seperated the lesion from the ulnar side of the dorsal branch of the digital nerve. Pathologic examination of the specimens revealed neurofibroma. At three-month follow-up, motor and sensory function were intact, and range of motion was fully recovered. Traumatic solitary neurofibroma is a rare tumor of the hand, especially in the finger. Hand surgeons should be aware of the diagnostic possibilities of this tumor based on examination, history taking and imaging studies.
Aged ; Fingers* ; Follow-Up Studies ; Hand ; Humans ; Male ; Neurofibroma* ; Neurofibroma, Plexiform ; Neurofibromatosis 1 ; Palpation ; Physical Examination ; Pigmentation ; Precipitating Factors ; Range of Motion, Articular ; Sensation ; Skin ; Ultrasonography

A patient underwent reconstruction of skin and soft tissue using V-Y advancement of a superior ulnar collateral artery perforator flap after resection of the scar tissue on the upper arm. Successful flap healing was observed without complications. The medial side of the upper arm is an ideal donor site because of its thin, elastic, and hairless skin, resulting in a well-hidden scar. The elasticity of the medial side of the upper arm allows primary closure after flap elevation. The superior ulnar collateral artery perforator flap is an option for reconstruction of the upper arm.
Arm* ; Arteries* ; Cicatrix ; Elasticity ; Humans ; Perforator Flap* ; Skin ; Tissue Donors