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Introduction: This work aims to assess lower limb free flaps spontaneous sensory recovery by comparing and analyzing a single standardized reconstructive procedure, namely the free noninnervated anterolateral thigh (ALT) flap in order to evaluate which flap or patient-related factors may predict flap reinnervation., Methods: Between January 2010 and March 2018 all nonreinnervated ALT flaps for lower limb coverage performed at our institution were screened. We excluded from the study flaps with less than 18 months of follow-up time, neurotized flaps, and those from patients who missed the last follow up. Sensory modalities that were evaluated included the two-point discrimination (2PD) test, measured in mm; and the Semmes-Weinstein monofilament (SWM) test, measured in gram. The sensory parameter results were compared and analyzed according to flap size (two groups; <160 cm 2 vs. > 160 cm 2 ), and post-op time of testing (two groups; <18-28 months vs. > 28 months)., Results: Twenty-one ALT free flaps were finally retained by this study. Our findings showed that flaps of smaller surface area showed a significantly better return in sensory discrimination 2PD and in sensory cutaneous pressure perception SWM testing., Conclusion: This work establishes for the first time some key quantitative data that can help predict free flap spontaneous reinnervation outcomes when using the same ALT flap. In our series, flaps surface remains the main discriminant value for a better sensory recovery.

Background: Traumatic earlobe is a frequently encountered problem in our practice. Numerous techniques have been published in the past decades including case reports, retrospective reviews, and prospective studies. However, to date, no study has investigated the overall complications or satisfaction rates associated with the wide spectrum of techniques., Objectives: This review aims to assess the outcomes of the various earlobe repair techniques and to provide a simplified classification system., Methods: This systematic review was performed in accordance with the PRISMA guidelines. PubMed database was queried in search of clinical studies describing surgical and non-surgical techniques, which reported techniques, indications, and outcomes., Results: Twenty-six studies, published from 1973 through 2019, were included. Six main technique categories were identified: These were straight-line closure (type 1, n = 82), Z-plasty (type 2, n = 165), flaps (type 3, n = 66), L-specular plasty (type 4, n = 35), double-curve specular plasty (type 5, n = 15), and non-surgical techniques (type 6, n = 38). Z-plasty (type 2) had the highest post-operative infection rate of 11.5%., Conclusions: While all the techniques are generally simple and efficient, they should be chosen based on both surgeon and patient preference. Complication rates and morbidity are relatively low., (© 2021 Wiley Periodicals LLC.)

Radical surgical debridement after Fournier gangrene (FG) can totally change anatomical balance between structures and compromise urogenital function. This is particularly true when the suspensory ligament and the lower abdominal wall are involved, leading to erection and sexual intercourse dysfunction.We present the case of a 48-year-old man, who underwent emergency debridement and split-thickness skin graft (STSG) of inferior abdominal wall, pubis, scrotal bag and penile shaft after Fournier gangrene.Five months after the emergency procedure, bilateral medial thigh flaps recreated the scrotal compartment, whereas a pedicled composite anterolateral thigh flap including fascia lata could cover the lower abdominal wall and rebuilt the penile suspensory ligament (PSL).Healing was uneventful and the patient returned to a normal sexual life with satisfactory erection and intercourse.Composite and/or chimeric anterolateral thigh fascia lata flaps have been previously used as a reliable option for complex defects, including tendon and ligaments. We describe here, the first case in the literature of a penile suspensory ligament reconstruction.

Background: Phalloplasty with the radial forearm free flap is associated with a large donor site defect., Aim: To compare two methods of donor site closure for functional and cosmetic long-term results: full-thickness skin grafting vs split-thickness skin grafting with MatriDerm., Methods: Thirty-seven transgender patients had a neophallus created from a radial forearm free flap, and all were operated on by the same senior surgeon. Eight patients had their donor site defect closed by total skin grafting and 29 patients, operated on after 2009, received a split-thickness skin graft with MatriDerm closure. All 37 patients were evaluated by questionnaire and by careful clinical examination. Pressure perception was assessed with the Semmes-Weinstein monofilament test. Sensory recovery, skin quality, and cosmetic result also were compared. The contralateral arm was used as the control., Outcomes: Pressure perception values showed better sensory return in the MatriDerm group. Split-thickness skin grafting with MatriDerm achieved superior results in skin sensibility, superficial radial nerve recovery, and cosmetic aspect., Results: Our findings support the hypothesis that MatriDerm can be used to preserve sensory function and decrease morbidity of the donor site., Clinical Implications: The use of a dermal substitute decreases the morbidity of the forearm free flap donor site., Strengths and Limitations: The strength of this study is its retrospective nature conducted of a prospectively maintained database of 37 consecutive radial forearm free flaps with superimposable dimensions and location performed by the same surgeon, thus limiting biases. A limitation is its small sample (particularly for the control group)., Conclusion: Our experience showed that the combination of a split-thickness skin graft with MatriDerm substantially decreases postoperative complications at the donor site defect on the forearm of transgender patients. Watfa W, di Summa PG, Meuli J, et al. MatriDerm Decreases Donor Site Morbidity After Radial Forearm Free Flap Harvest in Transgender Surgery. J Sex Med 2017;14:1277-1284., (Copyright © 2017 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)