Pedicled vastus lateralis musculofascial flap as a new technique for repairing rectourethral fistula after radical prostatectomy

We present a case of successful operative management of an iatrogenic rectourethral fistula with a pedicled vastus lateralis musculofascial flap. The fistula was created during radical prostatectomy operation. During the operation, it was deemed possible to spare this patient from a diverting colostomy and primarily repair a rectal injury. Postoperatively, however, a rectourethral fistula occurred, which was confirmed on retrograde urethrogram. A first attempt failed to close the fistula utilizing the transanal rectal flap advancement technique. A novel technique was attempted using a pedicled vastus lateralis musculofascial flap. This is the first report to our knowledge of repairing a rectourethral fistula with a pedicled vastus lateralis musculofascial flap. © 2011 Wiley‐Liss, Inc. Microsurgery, 2011     

Correction of cryptotia using a subcutaneous pedicled flap

Cryptotia is a relatively common deformity of the ear among orientals. Although many methods for correcting this deformity have been reported, there is no one perfect method. We have developed a method using a subcutaneous pedicle flap raised from the retroauricular region, where relative abundance of skin exists. We have treated 9 ears of 7 patients by the method reported herein. Results are satisfactory in all cases.     

A new pedicled seromuscular flap technique for high-risk intestinal anastomoses

A new method for protecting intestinal anastomoses in patients at high risk of anastomotic dehiscence or fistula formation is described herein. This method involves raising a seromuscular flap on a pedicle from the stump of the intestine to be anastomosed. The anastomosis is performed, then covered with the seromuscular flap.     

Longitudinal dorsal dartos flap for prevention of fistula after a Snodgrass hypospadias procedure

OBJECTIVES: The Snodgrass technique presents the procedure of choice for distal hypospadias. Fistula formation is the most common complication with various rates. We evaluated the importance of a urethral covering using vascularized dorsal subcutaneous tissue for fistula prevention. METHODS: Our study included 126 patients, aged 10 months to 16 years, who underwent hypospadias repair from April 1998 through June 2005. Of the patients, 89 had distal, 30 had midshaft and 7 had penoscrotal hypospadias. All patients underwent standard tubularized incised plate urethroplasty, which was followed by reconstruction of new surrounding urethral tissue. A longitudinal dorsal dartos flap was harvested and transposed to the ventral side by the buttonhole manoeuvre. The flap was sutured to the glans and the corpora cavernosa to completely cover the neourethra with well-vascularized subcutaneous tissue. RESULTS: Mean follow-up was 32 (6-87) months. A successful result without fistula was achieved in all 126 patients. In six patients, temporary stenosis of the glandular urethra occurred and was solved by dilation. CONCLUSIONS: A urethral covering should be performed as part of the Snodgrass procedure. A dorsal well-vascularized dartos flap that is buttonholed ventrally represents a good choice for fistula prevention. Redundancy of the flap and its excellent vascularization depend on the harvesting technique.     

Dorsal dartos flap for preventing fistula in the Snodgrass hypospadias repair

OBJECTIVE: To evaluate the importance of urethral covering using vascularized dorsal subcutaneous tissue for preventing fistula in the Snodgrass hypospadias repair. PATIENTS AND METHODS: The study included 67 children (aged 1-11 years) who had hypospadias repaired between April 1998 and May 2003, including 51 with distal and 16 with midshaft hypospadias. In all children, a standard tubularized incised-plate urethroplasty was followed by reconstruction of new surrounding urethral tissue. A longitudinal dartos flap was harvested from excessive dorsal preputial and penile hypospadiac skin, and transposed to the ventral side by a buttonhole manoeuvre; it was sutured to the glans wings around the neomeatus, and to the corpora cavernosa over the neourethra. Thus the neourethra was completely covered with well-vascularized subcutaneous tissue. RESULTS: At a mean (range) follow-up of 21 (6-65) months, the result was successful, with no fistula or urethral stenosis, in all 67 children. CONCLUSION: We suggest that urethral covering should be part of the Snodgrass procedure. A dorsal well-vascularized dartos flap, buttonholed ventrally, is a good choice for preventing fistula. Redundancy of the flap and its excellent vascularization depends on the harvesting technique.     

Vaginal pedicled flap for closure of vesicovaginal fistula

A 22-year-old woman presented with chronic urinary tract infections and was found to have an ectopic ureter. Repair involved ligation of the distal ectopic ureter via a vaginal approach. She developed an iatrogenic vesicovaginal fistula which was repaired with a vaginal pedicled flap.     

Ventral based dartos flap for the prevention of the urethrocutaneous fistula urethroplasty

Background:   Urethrocutaneous fistula is a common complication of urethroplasty for hypospadias even when a microsurgical technique is applied.
Methods:   From January 1999 to November 2006, we applied the ventral based dartos flap wrapping technique to prevent the occurrence of urethrocutaneous fistula in 34 patients with hypospadias.
Results:   Hypospadias was repaired without fistula formation in 31 patients while three patients developed a tiny fistula, which was later closed successfully by a simple procedure.
Conclusion:   We conclude that the ventral based dartos flap wrapping technique could be an alternative to the dorsal dartos flap for covering the neourethra with a vascularized flap because the procedure is very simple, and complications rarely occur.     

The repair of a congenital H-type urethrorectal fistula using a scrotal flap urethroplasty.

A rare case of congenital urethrorectal fistula associated with stenosis of the normally positioned anterior urethra is described. Previously reported embryologic explanations, a detailed approach for surgical management and an alternative treatment are discussed.     

Scrotal dartos flap for the prevention of the urethrocutaneous fistula on hypospadias urethroplasty

BACKGROUND: Urethrocutaneous fistula is a common complication of urethroplasty for severe hypospadias, even when a microsurgical technique is applied. PATIENTS AND METHODS: From June 2001 to July 2003, we applied the scrotal dartos flap wrapping technique to prevent the occurrence of urethrocutaneous fistula in 14 patients with hypospadias. RESULTS: Hypospadias was repaired without fistula formation in all but one patient, who developed a tiny fistula which was later closed successfully by a simple procedure. CONCLUSIONS: We recommend the scrotal dartos wrapping technique for covering the neourethra with a well-vascularized flap because of fewer complications, although the procedure to obtain the vascularized flap may take longer.     

Closure of orocutanous fistula using a pedicled expanded deltopectoral flap

Orocutaneous fistulas are associated with considerable morbidity. Closures of these fistulas are a challenge to the reconstructing surgeon. The aim of treatment is to provide healthy tissue to repair both the oral and cutaneous defects. The use of an expanded pedicled deltopectoral flap for the closure of an orocutaneous fistula in a patient who has undergone bilateral neck dissection and radiation is reported.     

Comparison of dartos flap and dartos flap plus spongioplasty to prevent the formation of fistulae in the snodgrass technique

Objective  

The aim of our study was to evaluate the role of paraurethral spongial tissue plus dartos flap using an additional urethral cover to prevent fistula formation in patients who underwent surgery with the Snodgrass technique.     

Dorsal double-layer dartos flap for preventing fistulae formation in the Snodgrass technique

INTRODUCTION: The Snodgrass technique and its modifications have become a preferred method for all varieties of hypospadias in the past decade. However, fistula is the most common complication of this technique. The aim of this study was to investigate the importance of the single and double flap to prevent fistula formation in the Snodgrass procedure. MATERIALS AND METHODS: Tubularized incised plate urethroplasty, using a single or the double flap, was undertaken in 74 consecutive boys (median age 6.6 years old, range 1-15) within the last 4 years. In the first 29 patients (group 1), a dorsolateral flap was rotated laterally for covering the neourethra and in the remaining 45 patients (group 2) the neourethra was covered with dorsal double dartos flaps. RESULT: In group 1, fistula in 4 patients and partial glanular dehiscence in 1 patient were detected. There was no fistula formation in group 2. CONCLUSION: For preventing fistula formation, urethral covering by a well-vascularized dorsal double-layer dartos flap should be the basic part of the Snodgrass procedure.     

含真皮下血管网真皮蒂鼻唇沟皮瓣修复鼻唇部缺损

目的探讨含真皮下血管网真皮蒂鼻唇沟皮瓣修复鼻唇部缺损的疗效。方法 2008年7月-2011年7月,应用含真皮下血管网真皮蒂鼻唇沟皮瓣修复鼻唇部缺损43例。男22例,女21例;年龄6～68岁,中位年龄36岁。缺损均为病变切除所致。其中黑色素痣23例,瘢痕16例,炎性肉芽肿4例;病程3个月～35年。病变部位:鼻尖11例,鼻翼10例,鼻翼、鼻尖10例,鼻翼沟8例,上唇4例。病变切除后缺损范围为0.7 cm×0.5 cm～1.2 cm×1.0 cm。皮瓣切取范围为1.0 cm×0.7 cm～1.5 cm×1.2 cm。结果术后皮瓣全部成活,创面Ⅰ期愈合;供区切口均Ⅰ期愈合。术后34例患者获随访,随访时间6～12个月,平均10个月。术后皮瓣色泽、弹性、质地与周围正常皮肤相似。供区无明显瘢痕。结论含真皮下血管网真皮蒂鼻唇沟皮瓣修复鼻唇部缺损具有皮瓣移位灵活、供区组织损伤小、术后皮下隧道臃肿发生率低等优点。     

Salvage of complete degloved digits with reversed vascularized pedicled forearm flap: a new technique

Complete ring avulsion injury necessitates a difficult choice between microvascular repair and revision amputation. Microvascular repair is technically difficult and amputation may leave an unsatisfactory result. We describe an alternative method whereby a reverse radial forearm flap is wrapped around the complete degloved digit. This provides good quality cover to the whole volar, dorsum, and both sides of the finger. We performed 26 pedicle radial forearm flaps for 26 patients in the Hand and Reconstructive Microsurgery Unit, Sohag University Hospital, from 2001 to 2009. Indications included soft tissue coverage of the thumb (n = 8), ring finger (n = 11), index finger (n = 4), middle finger (n = 2), and little finger (n = 1). Finger salvage was successful in 96% of patients. There was complete loss of 1 flap and partial flap loss of a second. Finger range of motion was excellent in 18 fingers, good in 7, and fair in 1. Two donor sites were closed primarily; the rest were closed with split-thickness skin grafts. There were no reports of cold intolerance of the hand or dysesthesias in the superficial radial nerve or lateral antebrachial nerve distribution.     

A new method for vaginal reconstruction using a pedicled jejunal flap

A technique for vaginal reconstruction is described that uses a pedicled jejunal flap. A neovagina was constructed using a segment of jejunum based on the fourth branch of the superior mesenteric artery. This provided an excellent result with adequate length, without the need for a lubricator or stent. Hypersecretion has not been observed.     

带蒂胸锁乳突肌肌瓣一期修复腮腺肿瘤术后缺损的疗效

目的通过与直接拉拢缝合比较,探讨带蒂胸锁乳突肌肌瓣修复腮腺肿瘤切除后缺损的疗效。方法回顾分析2002年1月-2010年4月,采用带蒂胸锁乳突肌肌瓣一期修复38例(肌瓣组)腮腺肿瘤切除后缺损患者的临床资料,与同期直接拉拢缝合修复的35例(对照组)患者进行比较。两组患者性别、年龄、病程、肿瘤类型及大小等一般资料比较,差异均无统计学意义(P<0.05),具有可比性。分析两组术后局部凹陷畸形、Frey综合征和腮腺瘘并发症发生情况。结果肌瓣组术后肌瓣均成活,创面Ⅰ期愈合;对照组切口均Ⅰ期愈合。术后两组患者均获随访,随访时间6～98个月。随访期间肿瘤均无复发。术后6个月两组患者面部凹陷畸形程度比较,差异有统计学意义(χ2=53.202,P=0.000)。肌瓣组术后发生1例(2.6%)腮腺瘘,1例(2.6%)Frey综合征;对照组分别为8例(22.8%)及20例(57.1%);两组并发症发生率比较差异均有统计学意义(P<0.05)。结论采用带蒂胸锁乳突肌肌瓣修复腮腺肿瘤切除后缺损,可预防术后局部凹陷畸形、Frey综合征和腮腺瘘并发症的发生。