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Objective: Topographic and blood vessel architecture study of the parietal area and distal regional pool of the superficial temporal artery (STA) to assess the possibility of revascularized cranium vault bone autograft formation., Material and Methods: For the topographic and anatomical study, 30 non-fixed corpses (17 male and 13 female) were selected, the average age of which was 59±5 years. In the anamnesis and catamnesis, there were no indications of trauma or other pathology of the head and neck, including vascular. STA was contrasted with a non-radiocontrast dye (brilliant green) with the introduction of the dye into the STA with preliminary ligation of the frontal branch of the STA. The area of blood supply to soft tissue and bone structures was studied. The angioarchitectonics of the parietal region was studied, the feeding vessel of the studied flap was identified., Results: The obtained anatomical landmarks for the collection of CPFP flap make it possible to form a flap with high accuracy and minimize the morbidity of the donor area.

The technique of urogenital plastic surgery continues to pose difficulties for surgeons due to physical features of the anatomical region, which complicates the correction of various severe male urogenital pathologies. The goal of the surgeon is to create a neophallus that allows for urination and intercourse with minimal damage to the donor site. This special topic provides a historical overview and principles for optimal phalloplasty. To improve results in latissimus dorsi free-flap phalloplasty, we share our approach, its benefits, and the lessons we have learned., Methods: We performed a retrospective review of patients who underwent shaft-only, two-stage or one-stage latissimus dorsi flap phalloplasty with or without reinnervation at a single institution from 1991 through 2020. Patients with a minimum of 1 year of follow-up were included. Data on the patient's demographics, the procedure, and the results of the operation were maintained., Results: In total, 592 latissimus dorsi flap phalloplasties were performed during the entire study period. Of the phalloplasties, 494 (83.5%) were performed for gender-affirming surgery, of which 470 were performed for transgender patients and 24 for intersex patients. Twenty-five patients (4.2%) had congenital malformations, 17 (2.9%) had oncologic resections, and 56 had posttraumatic loss (9.5%)., Conclusion: Latissimus dorsi flap total phalloplasty with reinnervation is currently one of the few methods that can solve not only an aesthetic problem, but also a functional one without the use of an endoprosthesis if the level of reinnervation and muscle contraction is sufficient., Competing Interests: The authors have no financial interests to declare in relation to the content of this article., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

The aim of the work is to present a modern view on the clinical application of urogenital flaps, such as autologous scrotal flap and foreskin. This plastic material has such characteristics as acceptable extensibility, good blood supply, accessibility and the absence of significant defects in the donor area. The use of urogenital flaps is an actual and promising direction in reconstructive urology. Unfortunately, currently there is not much literature data on the efficiency of using this type of flaps. Recent literature, both national and foreign studies, dedicated to using urogenital flaps, including comparative data with flaps of other localizations, are reviewed in the article. The review consists of several parts, corresponding to certain groups of nosologies, for the treatment of which urogenital flaps of different localization were used.

We report a comorbid patient after redo Frozen Elephant Trunk procedure followed by recurrent infection of thoracic aortic prosthesis, deep sternal wound infection and extensive soft tissue defect. Closure with skin-muscle thoracodorsal flap and graft-sparing technique with omentoplasty is an alternative to total graft replacement for thoracic aortic graft infection in comorbid patients with concomitant extensive defect of the chest wall or recurrent infection in early postoperative period.

Objective: To develop the algorithm for correction of defects following high-voltage electrical trauma with revascularized autografts, to assess the incidence and risk factors of postoperative complications., Material and Methods: Surgical interventions were performed in 16 men. Autografts were selected considering localization of defect and preoperative ultrasound data on perfusion of donor and recipient areas. We applied a sample with temporary compression of the vessels and ultrasound scanning of arteries and veins (a small-sized Doppler sound indicator of blood flow velocity - MINIDOP, BIOSS)., Results: Nine patients underwent microsurgical transplantation of revascularized flaps. Six patients with electrical trauma of the upper extremities underwent transplantation of free skin autografts and transposition of flexor and extensor muscles of the fingers in various combinations. In 1 patient, simultaneous microsurgical graft transplantation and plasty with local tissues were carried out. Microsurgical transplantation of thoracodorsal flap was performed in 2 patients with maxillofacial defect (with preliminary deepidermization of the flap in one case). In 3 patients with traumatic amputation of the penis, 2 patients underwent phalloplasty with a thoracodorsal flap and prefabrication of a radial forearm graft at the first stage. At the next stage, urethroplasty with a prefabricated radial forearm graft was performed. In 1 patient, closure of the penis defect was carried out using scrotal flaps., Conclusion: An integrated surgical approach, the use of free revascularized autografts and adequate postoperative management ensure high-quality aesthetic and functional restoration, improvement of the quality of life and social adaptation of patients with defects and deformations following high-voltage electrical injury.

Objective: To develop the method of masculinizing mammoplasty with nipple grafting female-to-male transsexuals with BMI >30 kg/m 2 , large breast volume and severe ptosis., Material and Methods: There were 114 mastectomies in 57 patients with nipple grafting technique. The methods of areola grafting and scar design were modified to improve aesthetic results. Inclusion criteria were BMI >30 kg/m 2 , breast size B+ and severe ptosis (Regnault grade ≥2). Anonymous survey for evaluation of aesthetic outcome and quality of life was performed a year after surgery., Results: Postoperative complications included hematoma (5.2%), seroma (7.9%), tangential graft necrosis (9.6%), wound dehiscence (0.8%), ligature-induced inflammation (1.7%), scar hypertrophy (12.2%). Three patients (5.2%) developed nipple hypersensivity in long-term postoperative period. Three patients (5.2%) required redo urgent surgery for hematoma. Additional surgical correction of scar hypertrophy was performed in 4 patients (7%). In a year after surgery, patients rated aesthetic postoperative result as 4.45 out of 5 scores., Conclusion: Masculinizing mammoplasty with areola autotransplantation is preferable for FtM transsexuals with large breast volume and severe ptosis. This surgery ensures a good aesthetic result with minimal secondary corrections and complication rate.

Correction of male urogenital pathology of different severity is complicated by the anatomical aspects of the penis. Skin texture, internal structures, and perfusion dynamics of the urogenital area make it a difficult area to reconstruct. We provide our experience with axial scrotal flaps for correction of penile defects of different severity and believe that these local flaps offer sufficient tissue characteristics for proper restoration of this complex region., Methods: Forty-eight patients were divided into 3 groups depending on penile defect genesis and severity. Axial scrotal flap reconstruction was used for the correction of defects in all cases, when necessary in combination with other flaps., Results: Axial scrotal flaps for total and subtotal penile reconstruction serve as valuable material for reconstruction of the urogenital area, and are to be combined with other flaps for restoration of bulk tissues. Localized defects of the penis and urethra reconstructed by axial scrotal flaps provide excellent aesthetic results with minimal scaring, stable perfusion dynamics, and high satisfaction rate., Conclusions: Scrotal tissues provide an excellent reconstruction material for penile defects because of their highly similar tissue structure as that of the penis. Scrotal axial flaps do not provide excess bulking in the postoperative period and are recommended for reconstruction of urethral and localized penile defects. Multistage surgery is recommended in cases of severe tissue damage, in combination with other flaps (inguinal, thoracodorsal, and radial)., (Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Aim: The aim of this study was to determine the possibilities of volumetric dynamic voiding multispiral computed cystourethrography (VDMMCT) for assessment of the lower urinary tract during voiding., Materials and Methods: VDMMCT was performed in a series of 22 patients with various urethral pathologies using 320 detector rows (640 unique slices; row width 0,5 mm). This method allows to cover the scan area of 16 cm per one rotation of the X-ray tube. In all patients, the cross-sectional area of the various urethral parts was estimated and the urinary bladder volume and average urine flow rate during all voiding phases were calculated., Results: VDMMCT was performed for dynamic evaluation of bladder volumes changes and analyzing a passage of contrasted urine throughout the urethra. The average volume of the urinary bladder was 356.3+/-179.9 ml, while the voiding volume was 299.5+/-154.8 ml. The average pre- and postoperative urine flow rate was 4.1+/-1.1 ml/s and 7.9+/-5.1 ml/s, respectively. The maximum urine flow rate was 19 ml/s. The average urethral diameter according to the VDMMCT after urethroplasty was 7.6+/-2.1 mm. The minimum length of urethral strictures was 17 mm, while the maximum length was 32 mm., Conclusion: Our results demonstrate the efficiency of the VDMMCT for assessing of the urethra throughout its length. VDMMCT can multidimensionally and dynamically represent the change of the bladder volume and the urine flow rate.

The article presents a rare case of urinary bladder reconstruction using thoracodorsal revascularized autograft in a patient with a bladder injury resulting from a road traffic accident. The area and size of the thoracodorsal flap (2215 cm) were determined using a 500 ml latex model of the bladder. The autograft was revascularized through external iliac vessels. From the thoracodorsal autograft, the dome was formed with the dermal part inward, which was fixed along its circumference to the bladder edges with 3/0 prolene sutures. The muscular part of the thoracodorsal flap was fixed along the perimeter to the remaining aponeurosis and covered by a free expanded cutaneous autograft. The surgery resulted in a newly constructed neobladder of sufficient volume (250-300 ml) with elements of the patients own bladder (posterior wall and neck) while sparing the patient from a cystostomy and improving his quality of life.

Micronucleus (MN) levels in exfoliated buccal mucosa cells of primary breast, cervix and corpus uteri cancer patients, and patients with benign tumors of uterus (myoma) and breast (fibroadenoma) were studied. Significantly increased number of MN in cells of cancer patients was observed compared to both healthy persons and patients with benign tumors. In patients with benign tumors no increase in MN quantity was observed. The evaluation of MN number in buccal mucosa cells shows genomic instability caused by malignant tumor in somatic cells of humans.

Of 57 patients who underwent microvascular free flap reconstruction of the plantar surface, 21 developed recurrent trophic ulcerations. Clinical and roentgenographic examination demonstrated that the recurrences were primarily traumatic in origin, resulting either from exogenous factors such as footwear or from endogenous factors such as osteophytes. A new method of surgically reconstructing the plantar aponeurosis was found to be effective in reducing the rate of recurrence.