Advancement Flap Research Articles

The Pacman Flap and Its Modifications for Reconstruction of Skin Cancer Surgical Wounds on the Scalp and Other Body Areas: A Review of 23 Cases

BackgroundThe Pacman flap is a modified V-Y advancement flap that showed to be versatile in repairing surgical and non-surgical wounds. Indeed, this flap has been used in any anatomical localization, except for the scalp, where its use has not been reported. Moreover, the versatility of the Pacman flap can be enhanced by applying simple modifications to its original design. Materials and methodsA case-series of 23 patients whose surgical breaches were repaired using standard or modified Pacman flap were included in this retrospective study. ResultsMost patients were male (65.2%) with a median age of 75.7 years. Squamous cell carcinoma was the tumor most commonly removed (60.9%), while scalp and face were the most frequent localizations (30.4%). Although 18 flaps were sculpted in the traditional Pacman shape, 5 were modified to fit the defect and localization. Complications occurred in 30% of flaps, but all of them were minor except for 1 extended necrosis. ConclusionsThe Pacman flap can be used to repair surgical wounds localized in any body area, including the scalp. Three modifications can enhance the versatility of the flap and offer new repair options to dermatologic surgeons.

Multiple coronally advanced flap with a selective use of connective tissue graft: A 3-year prospective clinical and histological study.

The purpose of the present study was to prospectively evaluate the 3-year changes in the gingival dimensions following multiple coronally advanced flap (MCAF) with selective use of connective tissue graft (CTG). In addition, the secondary aim was to histologically identify the factors related to phenotype changes. Twenty patients treated with MCAF and site-specific application of a CTG were available for the 3-year follow-up. Outcome measures included complete root coverage (CRC), recession reduction, keratinized tissue width (KTW), marginal tissue thickness changes, and primary flap position. Biopsies were harvested at one of the sites treated with the adjunct of CTG. All sections were stained with hematoxylin and eosin, Masson trichrome, Verhoeff-van Gieson, tenascin, and alcian blue stain for semiquantitative evaluation. At 3 years, CRC was detected in 86% of sites treated with MCAF alone and 81% of sites treated with MCAF+CTG. The 47% of sites treated with MCAF+CTG presented an apical shift of primary flap from its original position. Linear regression showed a significant association between KTW change and the initial KTW in MCAF-treated sites, while both initial KTW and position of primary flap were statistically significantly associated factors with KTW changes in the MCAF+CTG group. In all the biopsies examined, there is always a marked and clear separation between the connective tissue of the gingival flap and the palatal connective tissue of the graft. The selective use of CTG is an effective treatment for multiple gingival recessions. Only a limited increase in KTW can be expected in a bilaminar technique if, during the healing phases, the connective tissue is maintained completely covered.

D139. Aesthetic and Functional Outcomes following Reconstruction of Mohs Defects of the Lip: Analysis of 417 Cases

PURPOSE: Vermilion lip defects secondary to Mohs micrographic surgery (MMS) present significant challenges to the reconstructive surgeon. The association of reconstructive method with aesthetic and functional outcomes of the lip remains uncertain. METHODS: A retrospective review of patients who underwent MMS involving the vermilion lip between 2008-2022 was performed. Outcomes assessed included satisfactory appearance and function within 12 months, as reported at postoperative visits, complications, and revisions. Patients were stratified by the proportion of vermilion lip excised. Outcomes were analyzed using multivariable logistic regressions adjusting for patient-associated factors and with Chi-square tests. RESULTS: Four hundred seventeen patients were included. The mean defect area was 3.1±5.0 cm2 with 9.6% (n=40) of patients with defects involving >25% of the vermilion lip. Fifty-eight percent (n=244) were reconstructed with advancement flaps, 26% (n=108) with island pedicle flaps, and 10% (n=43) underwent complex reconstruction. Median follow-up duration was 89 days. Aesthetic and functional outcomes did not differ between patients with <25% versus 26-50% of the vermilion excised. Patients with >50% vermilion excised were significantly less likely to have satisfactory function (63.6% vs 99.4%, p<.001) and appearance (50.0% vs 91.5%, p=.004). Involvement of >25% vermilion was predictive of increased complications [OR=4.2, 95% CI: (1.6-11.0)] and revisions [OR=3.8, 95% CI:(1.5-9.4)]. Reconstructive method was not associated with any effect on aesthetics or function. CONCLUSION: Large MMS defects of the vermilion remain challenging to treat and were associated with greater rates of impaired function, appearance, complications, and revisions. Reconstructive method was not associated with alterations in function or appearance.

2. Cervicofacial Pediatric Tissue Expansion: A Single Surgeon’s 16-year Experience &amp; Aesthetic Unit-based Algorithm

PURPOSE: Tissue expansion is a powerful tool for the reconstruction of soft-tissue defects in pediatric patients. However, complications have been reported as high as 48% for cervicofacial pathology. Unique challenges include respecting the confluence of facial aesthetic units and avoiding ectropion. The senior author’s experience with pediatric cervicofacial tissue expander (TE) placement is presented with an aesthetic-unit based algorithm. METHODS: A retrospective study of pediatric patients who underwent cervicofacial TE placement by the senior author was performed over a 16-year period (1/2006 to 2/2022). Predictor and outcome variables were included. Univariate and multivariate logistics regressions were performed on all variables. A p≤0.05 was considered statistically significant. RESULTS: There were 111 TEs included with an 87.4% successful reconstruction rate. An aesthetic-unit based reconstructive algorithm is proposed based on the senior surgeon’s experience. Complications occurred in 21.6% of TEs. Iatrogenic ectropion was noted in 13.5% of patients; revisional surgery corrected 66.7% of cases. TEs that had at least one complication during expansion were significantly associated with the incidence of iatrogenic ectropion following flap advancement (O.R., 4.99; 95% C.I., 1.22-20.46; p=0.026). CONCLUSION: By using an aesthetic-unit based algorithm, pediatric cervicofacial tissue expansion can be optimized.

PC29. Surgical, Functional, and Survival Outcomes of Lip Reconstruction after Cancer Resection: A 20-year Experience at MD Anderson Cancer Center

PURPOSE: Lip reconstruction outcomes after head and neck cancer resection have been limited to small series. Herein, we report a 20-year experience with lip reconstruction in this population and delineate the rates and predictors of postoperative outcomes. METHODS: We conducted a retrospective cohort study of consecutive patients who underwent lip reconstruction following cancer resection from January 1994 to January 2015. Patient demographics, surgical characteristics, defect dimensions and flap type were correlated with surgical and functional outcomes using multivariable regression. RESULTS: We identified 244 patients with mean follow-up time of 28.7±37.6 months. Most defects involved the lower lip (44.0%, n=80), without oral commissure resection (67.6%). Lip advancement (21.0%), primary closure (16.2%), Webster-Bernard (11.4%), and folded-fasciocutaneous free flaps (11.4%) were the most common reconstruction techniques. A minority of patients developed surgical complications (25.2%), microstomia (16.7%), food intolerance (14.6%), oral incompetence (11.9%), speech difficulty (3.3%), lip tethering (2.4%), and dysphagia (1.9%). 5-year survival probability was 43.5%. Tobacco use (OR, 3.18; P=.007), diabetes mellitus (OR, 2.29; P=.035), and concurrent mandible reconstruction (OR, 2.31; P=.018) were associated with surgical complications. Recurrent disease (OR, 2.62; P=.043) and oral commissure resection (OR, 2.71; P<0.001) were associated with oral incompetence. Tobacco use (OR, 12.02; P=.023), concurrent upper and lower lip resection (OR, 4.70; P=.028), and larger upper lip resection size (OR, 13.8; P=.028) were associated with microstomia. CONCLUSION: Lip reconstruction after oncological resection may contribute to improved function with relatively low complication rates. Careful consideration of risk factors and preoperative planning is imperative for successful lip reconstruction outcomes.

Anatomical Considerations and Plastic Surgery Reconstruction Options of Sacral Chordoma Resection.

Introduction Chordomas are slow-growing malignant bone tumors arising from remnant embryonic notochord cells with predilection for the sacrum. They rarely metastasize, and early surgical resection with clear margins is the treatment of choice followed by plastic surgery reconstruction supplemented with adjuvant radiotherapy based on the local treatment protocol or in cases with a contaminated surgical field. Aim The aim of the present study is to present our experience in surgical management of sacral chordomas and propose a surgical reconstruction algorithmconsidering anatomical parameters after partial or total sacrectomy. Materials and methods Twenty-seven patients with sacral chordomas were treated in our Orthopaedic Surgery Department between January 1997 and September 2022, and 10 of them had plastic surgery reconstruction. Patients were divided into groups based on the type of sacrectomy, sacrum anatomical vascular or neural variations, partial or total, and the type of soft tissue reconstruction. The postoperative complications and the functional outcomes in each patient were assessed. Results Bilateral gluteal advancement flaps or gluteal perforator flaps are the first choice in patients with partial sacrectomy, intact gluteal vessels, and without preoperative radiotherapy followed by transpelvic vertical rectus abdominis myocutaneous flap or free flaps in those patients with near total sacrectomy and preoperative radiation therapy. Conclusion There are four reliable options for patients after sacral chordomaresection: direct closure, bilateral gluteal advancement flaps, transpelvic vertical rectus abdominis myocutaneous flaps,and free flaps. Each time, tumor-free margins and a good reconstructive plan according to the defect and patient characteristics are mandatory.

Comparative evaluation of modified triangular coronally advanced Flap alone or in combination with platelet rich fibrin or type I collagen membrane for treatment of Miller’s Class I and Class II gingival recession

The study aimed to clinically evaluate the outcome of modified triangular coronally advanced flap (mtCAF) alone or in combination with platelet rich fibrin or type I collagen membrane in Miller’s Class I and Class II gingival recession. 45 sites with Millers Class I or II gingival recession were recruited and allocated into 3 groups with 15 sites each. Group 1: mtCAF alone, Group II: mtCAF with PRF and Group III: mtCAF with bioresorbable collagen membrane (Bio-Gide®). Standardized Clinical Parameters such asPlaque Index (PI), Gingival Index (GI), Pocket Probing Depth (PPD), Clinical attachment level (CAL), Gingival Recession Depth (GRD) and Keratinized Tissue Height (KTH) were measured at baseline and 6 months. All the three groups showed improvement in clinical parameters but it was not statistically significant. However, a significant increase in keratinized tissue height was seen in Group III as compared to Group I and Group II. Modified triangular coronally advanced flap (mtCAF) alone or in combination with PRF and collagen membrane showed good clinical outcomes but better results were obtained in terms of keratinized tissue when collagen membrane was used.

Natural Umbilicoplasty Without Visible Scarring: An Easily Taught and Reproducible Technique

Abstract Goals/Purpose The umbilicus is a focal point in an abdominoplasty, but the variety of published techniques can create confusion when deciding which incision is optimal for inset. Recently, an excellent technique was described that results in a scarless caudal umbilicus with superior hooding (2022 Samargandi). A similar technique has been used by this abstract’s senior author (J.G.) for over 20 years and has subsequently been implemented in our residency training. The inset is accomplished through an inverted-V incision in the abdominoplasty flap. The technique avoids excessive vertical tension on the abdominoplasty closure, a complicating factor of aggressive abdominoplasty advancement that can lead to vascular compromise in the inferomedial aspect of the flap. Insetting the umbilicus prior to resection of this inferior excess can allow for greater advancement of the abdominoplasty and decreased risk of flap over-resection. Methods/Technique The umbilical inset through an inverted-V incision in the abdominoplasty flap has been performed in all the senior author’s (J.G.) patients over the past 20 years. Following inferior wedge resection of the native umbilical stalk, the apex of the inferiorly based (inverted-V) flap is sutured to the dermis of the umbilical stalk and to the rectus fascia. The superolateral margins of the native umbilicus are approximated to the abdominoplasty skin. The sole deep suture inferomedially tethers the most visible aspect of the umbilicoplasty to the abdominal wall. The inverted-V incision in the abdominoplasty flap prior to low transverse closure increases the vertical tension on the flap and enables a safe resection of the inferior excess tissue. This technique has been taught to all residents in our training program and quickly incorporated in our abdominoplasty closures. Results/Complications Incising the inverted-V in the abdominoplasty flap eases tension on the low transverse wound closure. All residents have been able to independently perform this technique. Among the patients who have undergone this technique, none have experienced necrosis of the inferior aspect of the abdominoplasty flap or of the umbilical stalk base. As gravity encourages relaxation of the abdominoplasty skin, the superior aspects of the umbilicoplasty are overshadowed by the resulting superior hooding. This technique yields a natural-appearing umbilicus with adequate depth and a camouflaged inferior inset. Our patients frequently comment on the “untouched” appearance of their umbilici. No patients have required revisions of the umbilical inset, and none have experienced necrosis of the inferomedial aspect of the abdominoplasty flap. Residents have reported quick integration and predictable umbilical positioning with this technique. Conclusion The technique is easy to teach and can be rapidly incorporated by surgeons in practice, as well as in training. We are excited to see this technique having recently been described and feel strongly that its widespread adoption should be entertained. The inset during abdominoplasty flap advancement, prior to final resection of the inferior excess skin, can simplify decision-making for where to position the umbilicus and how much inferior excess tissue to resect. In addition to realizing the aesthetic superiority of this umbilicoplasty technique, it is important to proclaim the benefit of insetting prior to final abdominoplasty closure and the intuitive sense with which the new position of the umbilicus can be determined.

Repair of fingertip defect with reverse digital artery island flap and repair of donor site with digital dorsal advancement flap.

The reverse digital artery island flap (RDAF) is widely used in repairing fingertip skin defects based on its good appearance and practicability. However, the donor area of the flap needs skin grafting, which can lead to complications. This retrospective study explored the clinical application of digital dorsal advance flap (DDAF) in repairing the donor site of the reverse digital artery island flap. From June 2019 to February 2022, 17 patients with a soft tissue defect of the finger had been restored with the reverse digital artery island flap, and at the same time, the donor area was repaired with digital dorsal advance flap (DDAF). The sensitivity, the active range of motion (ROM) and patient satisfaction were assessed after the operation. All flaps survived completely without skin grafting with only one linear scar. The sensory and motor functions of all patients recovered well. Assessment based on the Michigan Hand Outcomes Questionnaire (MHQ) showed satisfactory functional recovery for all patients. Reconstruction using RDAF combined with DDAF represents an effective alternative for repairing fingertip skin defects.

Topical Nitroglycerin versus Lateral fnternal Sphincterotomyin Treatment of Chronic Anal Fissure

Background: Anal fissure is common conditions that can affect people of all ages. Most anal fissures are at the rear of anal opening in line with cleft of the buttocks. There are many methods of treatment such as: medication by topical nitroglycerin or nifedipine paste or butulinum toxin injection or surgery by lateral internal Sphincterotomy or V-Y advancement flap.&#x0D; Objectives: Is to compare the result of topical GTN (chemical Sphincterotomy) as primary treatment of chronic anal fissure with lateral internal Sphincterotomy.&#x0D; Methods:&#x0D; Setting: In outpatient clinic and Tikrit teaching hospital from Jan. 2006 to Oct0.2007.&#x0D; Design: prospective study.&#x0D; This study compares the results of two different methods of treatment (chemical sphinecterotomy&amp;lateral internal Sphincterotomy) in 84 cases of chronic anal fissure regarding the efficacy and complication of these procedures.&#x0D; These cases were randomized in equal number into two groups:&#x0D; Group 1: were treated by chemical Sphincterotomy.&#x0D; Group 2: were treated by lateral internal Sphincterotomy.&#x0D; The average period of follow up after completion of treatment was 3 months for both groups.&#x0D; Results:&#x0D; Symptomatic improvement occurs in 30 patients treated by chemical Sphincterotomy (71.42%) at 12 weeks following treatment and 39 patients (92.85%) treated by lateral internal Sphincterotomy.&#x0D; No improvement occurs in 3 cases (7.15%) treated by chemical Sphincterotomy and no case who was treated by lateral internal Sphincterotomy.&#x0D; Conclusion: From this study we find that chemical Sphincterotomy induce rapid healing of chronic anal fissure with 71.42% rate in comparison to lateral internal Sphincterotomy with a 92.85% healing rate after 12 weeks treatment,

Septal Advancement Flap: Preserving, Restructuring, and Reshaping the Nasal Tip Contour with a Novel Flap.

Tip support and the tip's exact final position-rotation and projection-remain a main concern among rhinoplasty surgeons. The available options can be classified into two groups: septal extension graft (variations including tongue-in-groove) and columellar strut (with all its variations). There is still the possibility of nasal tip ligament(s) preservation-namely the interdomal ligament, when anchoraged cephalically to the anterior septal angle preserving the tip support. Including this panoply of solutions, the author has identified some challenges with insufficient outcome. Based on engineering concepts, a novel septal flap was developed to facilitate a preferred tip position and shape. The septal advancement flap (SAF) is a rotational-advancement flap of the superior and caudal aspects of the cartilaginous septum that enables the surgeon to create stable and accurate tip shape and position. This flap was designed following the spare roof technique B sequence, although it can be completed along with any technique of structure or preservation rhinoplasty.

Efficacy of Tunnel Technique (TUN) versus Coronally Advanced Flap (CAF) in the Management of Multiple Gingival Recession Defects: A Meta-Analysis.

We systematically assessed the efficacy of tunnel technique (TUN) vs. coronally advanced flap (CAF) in the management of multiple gingival recession defects in adults. Five databases were searched until September 2021 for randomized controlled trials (RCTs) assessing TUN vs. CAF; grafts of interest were acellular dermal matrix (ADM) and connective tissue graft (CTG). Primary outcomes were root coverage (RC) and complete root coverage (CRC). Secondary outcomes were clinical attachment level (CAL), keratinized tissue width (KTW), probing depth (PD), and recession coverage (REC). Effect measures were risk ratio (RR) or mean difference (MD) with their confidence intervals (95% CI). Inverse variance methods and random-effects model meta-analyses were used. Subgroup analyses by the type of graft were performed. Quality of evidence was assessed using GRADE methodology. Five RCTs (n = 173) were included, with a follow-up of 6 months for all outcomes. In comparison to CAF, TUN did not significantly reduce CRC (RR 0.65; 95% CI 0.002-176.7; p = 0.51) and did not increase RC (MD 0.99%; 95% CI -6.7 to 8.6; p = 0.80). In comparison to CAF, TUN showed no significant reduction of secondary outcomes. Subgroup analyses by type of graft showed no differences in comparison to primary analyses for primary and secondary outcomes. Three RCTs had a high risk of bias, and five RCTs had very low quality of evidence for all outcomes. In adults with gingival recessions, TUN had similar primary and secondary outcomes in comparison with CAF. Subgroup analyses by the type of graft did not affect main conclusions. More RCTs with better design are needed to further characterize the effects of TUN vs. CAF in the treatment of multiple gingival recession defects.

MP15-13 FAVORABLE SAFETY OUTCOMES OF DELAYED PRIMARY CLOSURE OF LARGE FOURNIER’S GANGRENE SKIN DEFECTS

You have accessJournal of UrologyCME1 Apr 2023MP15-13 FAVORABLE SAFETY OUTCOMES OF DELAYED PRIMARY CLOSURE OF LARGE FOURNIER’S GANGRENE SKIN DEFECTS Sailakshmi Senthil Kumar, Helen Sun, Nicholas Sellke, Kimberly Tay, Donald Bodner, Shubham Gupta, Kirtishri Mishra, and Kyle Scarberry Sailakshmi Senthil KumarSailakshmi Senthil Kumar More articles by this author , Helen SunHelen Sun More articles by this author , Nicholas SellkeNicholas Sellke More articles by this author , Kimberly TayKimberly Tay More articles by this author , Donald BodnerDonald Bodner More articles by this author , Shubham GuptaShubham Gupta More articles by this author , Kirtishri MishraKirtishri Mishra More articles by this author , and Kyle ScarberryKyle Scarberry More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003235.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Fournier’s gangrene (FG) is a necrotizing infection of the male genitalia associated with significant loss of genital tissue. Traditionally, loss of >50% of scrotal skin is thought not to be amenable to primary closure and is often left to heal by secondary intention due to concern for infection recurrence. We hypothesize that delayed primary closure (DPC) for FG patients is feasible and safe for large skin defects. METHODS: A single institution retrospective review was done from October 2020 to October 2022 of adult males that underwent DPC for FG. Patients were assessed for overall stability at serial debridements and a healthy wound bed prior to closure. All patients had minimum follow-up at 1 and 4 weeks for drain removal and wound check. Additional follow-ups were scheduled as needed. Clinical data including demographics, medical history, length of stay, operative details, and complications were collected. RESULTS: We identified 13 patients that underwent DPC. Average age was 61.3 years and average BMI was 36.2 kg/m2. The majority of patients had hypertension and/or diabetes mellitus (84.6%). Median number of FG debridements was 2 (IQR 2-3), with a median time to closure of 6 days (IQR 3-11) and length of stay of 11 days (IQR 9-16). Average genital defect size was 119 cm2 (range 44-346 cm2). Five patients (38.4%) were closed using scrotal flaps alone; other closures used advancement flaps from the inner thigh, lower abdomen, and perineum. There were 4 Clavien-Dindo III complications: 2 partial flap necrosis, 1 wound dehiscence, and 1 instance of bleeding. Three were successfully managed by re-exploration and re-closure. One flap failure occurred in a patient with pre-existing radiation and rectourethral fistula. After re-closure attempt, the wound re-opened and was left to heal by secondary intention. The majority of patients were able to be discharged home directly (69.2%). At an average follow-up of 3.5 months, 46.2% of patients had no known complications. One patient (7.7%) experienced superficial genital cellulitis at 6.5 weeks post-op which was successfully managed with antibiotics. CONCLUSIONS: Our data from a single institution shows that DPC is safe and effective with few infectious sequelae. Patients with large defects may benefit from less complex wound management requirements and discharge directly to home. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e197 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sailakshmi Senthil Kumar More articles by this author Helen Sun More articles by this author Nicholas Sellke More articles by this author Kimberly Tay More articles by this author Donald Bodner More articles by this author Shubham Gupta More articles by this author Kirtishri Mishra More articles by this author Kyle Scarberry More articles by this author Expand All Advertisement PDF downloadLoading ...

Design Analysis of Flap Slat Control Computer

The design of high safety and reliability slat flap control computer (SFCC) has become the main objective of flight control development. Firstly, the design requirements proposed. Secondly, the design of foreign advanced civil aircraft flap slat computers is summarized. Based on one type of aircraft SFCC design, the operation mode, redundancy management, synchronization, and monitoring design of the SFCC are analyzed in detail, and a design scheme of civil aircraft SFCC, which meets the requirements of safety and reliability, is proposed. Based on SFC real-time test environment, the SFCC design logic is verified. Taking the design and test of the flap motor direction error monitoring as an example, the test results show that the scheme design is reasonable and feasible, and the reliability of the flap slat computer is effectively improved.

Comparative analysis of coronally advanced flap using platelet-rich fibrin membrane and amniotic membrane in gingival recession

Comparative analysis of coronally advanced flap using platelet-rich fibrin membrane and amniotic membrane in gingival recession

Reconstruction of Interdental Papillae using Composite Resin Restoration and Modified Coronally Advanced Flap Technique with Sub-Epithelial Connective Tissue Graft- A Case Report with 1- Year Follow-Up

Reconstruction of Interdental Papillae using Composite Resin Restoration and Modified Coronally Advanced Flap Technique with Sub-Epithelial Connective Tissue Graft- A Case Report with 1- Year Follow-Up

V07-06 SINGLE-PORT ROBOTIC TRANSVESICAL SIMPLE PROSTATECTOMY STEP BY STEP

You have accessJournal of UrologyCME1 Apr 2023V07-06 SINGLE-PORT ROBOTIC TRANSVESICAL SIMPLE PROSTATECTOMY STEP BY STEP Joshua Jue, Alexa Meyer, and Lee Richstone Joshua JueJoshua Jue More articles by this author , Alexa MeyerAlexa Meyer More articles by this author , and Lee RichstoneLee Richstone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003288.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The single-port robotic transvesical simple prostatectomy was first described in 2020, but the operation has not been widely adopted. With promising early results, the single-port robotic transvesical simple prostatectomy is an alternative approach to this operation with distinct advantages. METHODS: We detail the instruments required for this procedure, as well as the surgical technique to perform a simple prostatectomy using the single-port robot. Intraoperative and robotic video demonstrates all aspects of the technique, and postoperative photos illustrate the healed wound. RESULTS: A 3 cm transverse incision is made 3 fingerbreadths above the pubic symphysis and a longitudinal cystotomy is made. The Roll Wound Retractor rolling ring is inserted into the bladder lumen, with the Access Port, SP Short Entry Guide and AirSeal trocar within it. The robot is then docked to the SP cannula, and the bladder is insufflated to 8 mmHg. A semilunar incision is made through the bladder mucosa using the monopolar scissors along the posterior aspect of the bladder neck or median lobe. The forceps can be used to retract the prostatic adenoma, while using the monopolar scissors to further bluntly dissect the adenoma from the capsule. The prostatic adenoma can be removed en bloc, but is usually removed en lobe. A vesicourethral mucosal advancement flap is performed with 3-0 V-lock suture from apex to base at 3 o-clock and 9 o-clock; a double-arm 3-0 v-clock suture is then used to approximate the bladder and urethral mucosa, by running from 6-o-clock to 12-o-clock. The cystotomy is closed in 2 layers with 3-0 vicryl suture. The patient is observed for 2 hours on continues bladder irrigation to determine ambulatory discharge eligibility. Follow up is in 3-7 days for trial of void. CONCLUSIONS: Single-port robotic transvesical simple prostatectomy is a safe and effective way to surgically remove benign glands larger than 80 cc. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e597 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joshua Jue More articles by this author Alexa Meyer More articles by this author Lee Richstone More articles by this author Expand All Advertisement PDF downloadLoading ...

COMPARATIVE EVALUATION OF MODIFIED TRIANGULAR CORONALLY ADVANCED FLAP IN COMBINATION WITH PLATELET RICH FIBRIN OR TYPE I COLLAGEN MEMBRANE FOR TREATMENT OF MILLERS CLASS I AND CLASS II GINGIVAL RECESSION

Background: The study aimed to clinically evaluate the outcome of modified triangular coronally advanced flap (mtCAF) alone or in combination with platelet rich fibrin or type I collagen membrane in the treatment of Millers Class I and Class II gingival recession. Methods: 45 sites with Millers Class I or II gingival recession were recruited and allocated into 3 groups with 15 sites each. Group 1: mtCAF alone, Group II: mtCAF with PRF and Group III: mtCAF with bioresorbable collagen membrane (Bio-Gide®). Standardized Clinical Parameters such as Plaque Index (PI), Gingival Index (GI), Pocket Probing Depth (PPD), Clinical attachment level (CAL), Gingival Recession Depth (GRD) and Keratinized Tissue Height (KTH) were measured at baseline and 6 months. Result: All the three groups showed improvement in clinical parameters but it was not statistically significant. However, a significant increase in keratinized tissue height was seen in Group III as compared to Group I and Group II. Conclusion Modified triangular coronally advanced flap (mtCAF) alone or in combination with PRF and collagen membrane showed good clinical outcomes but better results were obtained in terms of keratinized tissue when collagen membrane was used.

CLINICAL CHARACTERISTICS AND RESULT OF LOCAL FLAP RECONSTRUCTION FOR FINGERTIP INJURY IN ADULTS

Background: Fingertip injury at different levels is a common injury and management varies with variable outcomes. Local flap reconstruction techniques are the most commonly used method of treatment with satisfactory results in most. The current study aimed to analyze the clinical characteristics and results of different local flap reconstruction techniques in the treatment of fingertip injuries. Methods: This was a retrospective observational study of 31 fingertip injuries in 24 patients treated with one of the three local flap reconstruction techniques; V-Y advancement flap, thenar flap, and Moberg flap, performed by a single orthopedic surgeon in a tertiary care teaching hospital over 2 years period. The variables analyzed were demographic and injury characteristics, flap take-up function, and cosmesis of the finger and nail using descriptive statistics. Results: There were a total of 31 fingertip injuries at different levels and morphology with a mean age of 35.79 years (range 18-55). Household tools or machine-related injury was the most common mode of injury. A total of 23 (74%) fingertip amputations at a different level were treated with V-Y advancement local flap, 5 cases with thenar flap, and 3 cases of thumb tip amputation and laceration with Moberg flap. All the flaps survived well with preservation of sensation, function, and acceptable cosmesis. Conclusions: Local flap reconstruction techniques can give rise to consistently good results in the management of fingertip injury. They are technically simple, and reliable and should be practiced by all orthopedic trauma surgeons whenever it is indicated.

Two-Stage Penile Reconstruction after Paraffin Injection: A Case Report and a Systematic Review of the Literature

Penile injection of foreign materials is an obsolete practice often performed by non-medical personnel in order to enlarge penile size. A systematic review of the literature from 1956 to 2022 was conducted in accordance with the general guidelines recommended by the Primary Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. We included full papers published from 1956 to 2022. We also described a case report of a 23 year old Bulgarian male affected by penile paraffinoma who underwent a 2-stages surgical technique. A total of 152 cases have been reported, with a median age of 37.9 ranging from 18 to 64 years. Six different techniques have been described in the whole literature: bilateral scrotal flap, simple excision of the paraffinoma with primary closure, two-stage scrotum skin flap, medial prepuce-soprapubic advancement flap technique and penile reconstruction using split thickness skin graft (STSG) or full thickness skin graft (FTSG). An analysis of the distribution among early and late complications was then carried out. In our experience, among the variety of surgical techniques described, a two-stage penile reconstruction using scrotal skin results in excellent cosmetic and functional outcomes, with a low rate of complications.