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Background This experimental study investigates the use of vascularized fascia as carrier for prelaminated cartilage and bone flaps. Methods A total of 30 male New Zealand white rabbits were divided into two equal groups (A and B). The fascia surrounding the inguinal fat and superficial inferior epigastric vessels was dissected. In group A, the fascia was wrapped around a template (20 × 40 mm) of cartilage harvested from the rabbit's ear. In group B, the fascia was wrapped around a 15 × 35 mmpiece of rib cortical bone. After amaturation period of 4 weeks, group A was subdivided into three groups (A1, A2, and A3). In group A1 (six animals) the animals were sacrificed and the flaps were sent for histological examination, in A2 (six animals) the flaps were rotated 180 degrees and anchored at knee level, and in A3 (two animals) the flaps were transferred as free flaps to the right SIE (superficial inferior epigastric vessels). The animals of subgroups A2 and A3 were sacrificed after another maturation period of 2 weeks and the flaps were sent for histological examination. After a maturation period of 6 weeks, group B was subdivided into three subgroups (B1, B2, and B3) corresponding to the cartilage subgroups. Subgroups B2 and B3 were sacrificed after 2 weeks. Results All flaps of groups A and B demonstrated good viability apart from one specimen of subgroup B2. Angiogenesis was present in all groups. Conclusion Meticulously dissected vascularized fascia can be successfully used for prelamination of complex fasciocartilaginous or osseofascial flaps. The required maturation periods are 4 and 6 weeks, respectively. [ABSTRACT FROM AUTHOR]

Background Free tissue transfer is commonly required for reconstruction of distal third lower extremity injuries. Injuries involving the dorsal surface of the foot require thin pliable flaps. Musculocutaneous flaps are often too bulky to accommodate shoewear. Fasciocutaneous flaps, while an improvement, need secondary contouring procedures. The modified radial forearm fascial flap (MRFFF) may offer an alternative. Methods Twelve patients with distal third lower extremity wounds were reconstructed with MRFFF + split thickness skin graft. The modification in flap design leaves fascia radial to the pedicle unharvested, preserving sensibility of the dorsoradial aspect of the hand. Flaps were covered with a skin graft after inset. Donor sites were closed primarily. Results Nine wounds were traumatic-five with exposed hardware, one burn, one diabetic ulcer, and one wound dehiscence following sarcoma resection + radiation. Out of 12, 11 limbs were salvaged at 1 to 2 years follow-up. All patients ambulated on the reconstructed leg and wore a shoe comfortably. Average time to weight bearing was 2 months. The donor site was limited to 25-cm scar on the volar forearm. No persistent motor/sensory deficits occurred in donor arms. Conclusion MRFFF is an excellent flap for reconstruction of the distal lower extremity. Flap contour allows excellent shoe-fitting without secondary revisions. Replacement of the adipocutaneous flap on MRFFF donor site eliminates the need for a conspicuous donor-site skin graft. The ulnar orientation of the harvested fascia prevents sensory loss in the dorsal hand. The MRFFF provides the ideal replacement of "like with like" for selected distal lower extremity wounds. [ABSTRACT FROM AUTHOR]

Background The aim for microsurgical reconstruction has broadened from achieving functional to also providing good esthetic outcomes. The perforator flaps are widely used for this goal. However, perforator flaps can still be bulky especially to resurface the skin defect. We hypothesized that elevation from the superficial fascial plane can obtain a thin and viable flap. Method In this retrospective study, we report consecutive perforator flaps elevated at the superficial fascial plane from November 2007 to July 2013. Total of 304 flaps which were 196 superficial circumflex iliac perforator (SCIP) flaps, 81 anterolateral thigh (ALT) flaps, and 27 gluteal artery perforator (GAP) flaps were reviewed. Result The patient group composed of 189 male and 115 female patients with an average age of 35.8 years. The average bodymass index was 23.5 kg/m² (range, 15.91- 34.57 kg/m²). All 304 flaps were successfully elevated with this approach with at least one viable perforator. The thickness averaged approximately 6 mm for ALT flap (range, 4-11mm), 5 mm for SCIP flap (range, 3-12mm), and 8.5 mm for GAP flap (range, 5-11 mm). Complete survival was noted in 282 flaps, partial loss of flaps requiring secondary procedures in 6 cases, partial loss healing secondarily in 8 cases, and total loss in 9 cases. During the average follow-up of 34 months, secondary debulking procedures were required in six flaps. Conclusion This newapproach of elevation on the superficial fascia is reliable, provides a viable tissue, and is able to obtain a thin flap achieving good functional and esthetic outcome. [ABSTRACT FROM AUTHOR]

The primary closure of abdominal fascia after breast reconstruction with transverse rectus abdominis myocutaneous (TRAM) flap has been reported to be the most effective way to reduce these complications. A total of 108 patients who underwent immediate unilateral breast reconstruction with muscle-sparing TRAM flap were included in the study. We compared complications between 56 patients who underwent conventional primary fascial closure (group 1) and 52 who underwent fascial closure in a new double-breasted jacket pattern (group 2), retrospectively. Abdominal bulging occurred in four patients (7.1%) in group 1 and one patient (1.9%) in group 2 (p = 0.01). An abdominal wound dehiscence occurred in three (5.4%) patient in group 1 and two (3.8%) patient in group 2 (p = 0.12). After conventional or muscle-sparing TRAM free flap reconstruction, closing the abdominal fascia in a double-breasted jacket pattern can help reinforce the lower abdominal fascia and prevent abdominal bulging caused by abdominal fascia tensional imbalance. [ABSTRACT FROM AUTHOR]

The article describes the case of a 30 year old male prisoner with a history of gender identity disorder and schizophrenia who was presented to the hospital following a self-inflicted penile amputation with a knife. Topics discussed include attempts for reattachment and the abdominal fascia repaired with O-braided Ethibond suture. It suggests that deep inferior epigastric vessels are suitable as recipients in cases of penile replantation in the absence of local alternatives.